Article Text

PDF
Paper
Resuscitation decisions at the end of life: medical views and the juridification of practice
  1. Fiona MA MacCormick1,
  2. Charlotte Emmett2,
  3. Paul Paes3,
  4. Julian C Hughes4
  1. 1 Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
  2. 2 Northumbria Law School, Northumbria University, Newcastle upon Tyne, UK
  3. 3 School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
  4. 4 Bristol Medical School, University of Bristol, Bristol, UK
  1. Correspondence to Dr Fiona MA MacCormick, Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE24AX, UK; fiona.maccormick{at}ncl.ac.uk

Abstract

Background Concerns about decision making related to resuscitation have led to two important challenges in the courts resulting in new legal precedents for decision-making practice. Systematic research investigating the experiences of doctors involved in decisions about resuscitation in light of the recent changes in law remains lacking.

Aim To analyse the practice of resuscitation decision making on hospital wards from the perspectives of doctors.

Design The data presented in this paper were collected as part of a wider research study of end-of-life care in an acute hospital setting. Data collection comprised ethnographic non-participant observation on two acute hospital wards and individual interviews with patients, relatives and healthcare professionals caring for patients thought to be approaching the end of life. Data were analysed using a constructivist grounded theory approach.

Results Discussions and decision making about resuscitation present many challenges for those involved on acute medical wards. The data highlight the potential for multiple interpretations of legal precedents, creating misunderstandings that may impact patient care in less positive ways.

Conclusions This paper provides unique insights into how doctors respond to the changing medico-legal culture and the subsequent effects on patient care. It demonstrates how the juridification of medical practice can occur. It highlights the potential benefit of a structure to support clinicians, patients and relatives in discussing and navigating decisions around care at the end of life in line with the patient’s wishes and preferences. Recommendations for future research are made and legal ramifications are discussed.

  • end of life care
  • applied and professional ethics
  • clinical ethics
  • decision-making

Statistics from Altmetric.com

Footnotes

  • Contributors FMAM undertook the research, helped to conceive the paper, wrote the original draft of the paper, contributed to subsequent drafts, prepared the final draft and is responsible for the overall content as guarantor. PP planned and supervised the research, helped to conceive the paper, contributed to each draft and has read and approved the final draft. CE helped to conceive the paper, contributed to each draft and has read and approved the final draft. JCH planned and supervised the research, helped to conceive the paper, contributed to each draft and has read and approved the final draft.

  • Funding This research was part of a three year doctoral study funded by Northumbria Healthcare NHS Foundation Trust.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by NRES Committee North East—Newcastle & North Tyneside 1 (Reference 14/NE/0104).

  • Provenance and peer review Not commissioned; externally peer reviewed.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.