"I don't need my patients' opinion to withdraw treatment": patient preferences at the end-of-life and physician attitudes towards advance directives in England and France.

Ruth Horn

doi:10.1007/s11019-014-9558-9

Abstract

This paper presents the results of a qualitative interview study exploring English and French physicians’ moral perspectives and attitudes towards end-of-life decisions when patients lack capacity to make decisions for themselves. The paper aims to examine the importance physicians from different contexts accord to patient preferences and to explore the (potential) role of advance directives (ADs) in each context. The interviews focus on (1) problems that emerge when deciding to withdraw/-hold life-sustaining treatment from both conscious and unconscious patients; (2) decision-making procedures and the participation of proxies/relatives; (3) previous experience with ADs and views on their usefulness; and (4) perspectives on ways in which the decision-making processes in question might be improved. The analysis reveals differences in the way patient preferences are taken into consideration and shows how these differences influence the reasons physicians in each country invoke to justify their reluctance to adhering to ADs. Identifying cultural differences that complicate efforts to develop the practical implementation of ADs can help to inform national policies governing ADs and to better adapt them to practice.

Highlights

Respect for patient autonomy is an essential element of modern medical ethics (Beauchamp and Childress 2008)
In England,1 patient autonomy has a central place in health care law, and it underpins the respect that must be granted to a competent patient’s refusal of treatment
Drawing upon an analysis of interviews with French and English doctors, this study shows how patient preferences are taken into consideration in different social and cultural contexts and how these differences influence physicians’ perspectives and attitudes towards advance directives (ADs)

Summary

Introduction

Respect for patient autonomy is an essential element of modern medical ethics (Beauchamp and Childress 2008). There are instances in which a patient is not able to communicate her will, such as when people are kept alive in chronic and at times critical condition These kinds of cases raise difficult questions about how to respect people who cannot communicate. In England, patient autonomy has a central place in health care law, and it underpins the respect that must be granted to a competent patient’s refusal of treatment As already formulated in the common law (Re T (adult: refusal of treatment) [1992]; Re AK (medical treatment: consent) [2000]; HE v A Hospital NHS Trust [2003]; W Healthcare NHS Trust v H and others [2004]), an AD must be issued voluntarily by a competent and sufficiently informed patient, and apply to the circumstances that have arisen. This clause allows patients to empower someone to make health care decisions on their behalf when they have lost the capacity to decide for themselves.

Objectives

Methods

Conclusion