Objective To increase knowledge of how doctors perceive futile treatments and scarcity of resources at the end of life. In particular, their perceptions about whether and how resource limitations influence end-of-life decision making. This study builds on previous work that found some doctors include resource limitations in their understanding of the concept of futility.
Setting Three tertiary hospitals in metropolitan Brisbane, Australia.
Design Qualitative study using in-depth, semistructured, face-to-face interviews. Ninety-six doctors were interviewed in 11 medical specialties. Transcripts of the interviews were analysed using thematic analysis.
Results Doctors’ perceptions of whether resource limitations were relevant to their practice varied, and doctors were more comfortable with explicit rather than implicit rationing. Several doctors incorporated resource limitations into their definition of futility. For some, availability of resources was one factor of many in assessing futility, secondary to patient considerations, but a few doctors indicated that the concept of futility concealed rationing. Doctors experienced moral distress due to the resource implications of providing futile treatment and the lack of administrative supports for bedside rationing.
Conclusions Doctors’ ability to distinguish between futility and rationing would be enhanced through regulatory support for explicit rationing and strategies to support doctors’ role in rationing at the bedside. Medical policies should address the distinction between resource limitations and futility to promote legitimacy in end-of-life decision making.
- medical futility
- resource allocation
- health care rationing
- clinical decision-making
- withholding treatment
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Contributors All authors created the study design and qualitative data collection methods for the broader project. EC conceived of this study and oversaw all aspects, including writing. BPW and LW contributed to the data analysis and manuscript writing. CG contributed to key elements of the data analysis approach. All authors discussed the content of the article, critically revised multiple drafts of the manuscript and approved the final version.
Funding This research was funded by the Australian Research Council Linkage Projects scheme (project no. LP121000096) and the Royal Brisbane and Women’s Hospital. EC was supported by an Australian Government Research Training Program Scholarship and a National Health and Medical Research Council Centre of Research Excellence in End-of-Life Care Top-Up Scholarship.
Competing interests None declared.
Ethics approval Multicentre approval from Royal Brisbane and Women’s Hospital (approval no. HREC/12/QRBW/429) and from participating universities.
Provenance and peer review Not commissioned; externally peer reviewed.
Patient consent for publication Not required.