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Deciding who decides: An interview study exploring the factors affecting emergency department and intensive care unit health professionals’ understanding and application of the law on end-of-life decision-making
Journal article   Open access   Peer reviewed

Deciding who decides: An interview study exploring the factors affecting emergency department and intensive care unit health professionals’ understanding and application of the law on end-of-life decision-making

Jayne Hewitt, Katya May, Nemat Alsaba, Kerina Denny, Colleen Cartwright, Lindy Willmott, Ben White and Andrea P. Marshall
Australian critical care, Vol.38(5), pp.1-7
09/2025
DOI: https://doi.org/10.1016/j.aucc.2025.101271
PMID: 40592167
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Abstract

Advance health directive Critical care Emergency care End-of-life decision-making Substitute decision-makers Withholding treatment
All health care is underpinned by legal frameworks, including those that regulate who is responsible for healthcare decisions at the end of life. How these frameworks support decision-making in emergency departments (EDs) and intensive care units (ICUs) is underexplored. The objective of this study was to identify factors that help or hinder healthcare professionals' understanding and application of the law that applies to end-of-life decision-making in the EDs and ICUs in Queensland, Australia. A descriptive qualitative study based on naturalistic inquiry was undertaken. Participants were healthcare professionals working in the ICUs or EDs of one South East Queensland Hospital and Health Service, responsible for the care of adult patients who had died. Thirteen medical practitioners, 19 registered nurses, and three social workers participated in semistructured interviews. Three themes and eight subthemes were identified in the data. First, the theme the complexity of communication is laid bare at the end of life described the challenges associated with talking about death and dying and the need to reframe conversations where death is inevitable. Next, the theme decision-making has layers highlighted family inclusion in decisions, navigating different perspectives to share decision-making and acknowledging that decision-making is emotionally burdensome. Finally, the theme how the law should apply is uncertain described the difficulties in deciding who should decide, knowing when Advance Health Directives can be relied on, and the need to reduce legal risk. Decision-making at the end of life is complex and challenging. Healthcare professionals charged with leading conversations find them challenging and are mindful of the burdens associated with such decisions. The need to work within the legal framework is acknowledged, but applying the law can be difficult.

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