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UK Doctors Dont Take End-Of-Life Decisions Lightly, Finds Brunel University Academic

• Study compares UK doctors with those in other countries with different legal positions
• 88% of end-of-life decisions were estimated to have shortened life by less than one week
• UK doctors found particularly likely to consult with medical and nursing colleagues and highly likely to consult with patients and families about end-of-life decisions, contrary to some claims
• This evidence indicates a strong palliative care philosophy in the UK.
Further results of the first UK-wide study into end-of-life decisions made by doctors are reported today in Palliative Medicine. The survey, which was carried out by Prof. Clive Seale, Brunel University, assessed the extent to which UK doctors discussed end-of-life decisions with patients, relatives and colleagues, and the degree to which patients' lives are shortened by end-of-life decisions (ELDs).
The survey of 857 UK medical practitioners found:
• UK doctors, compared with doctors in other countries, are cautious about shortening life by more than a few days - in 88% of cases where there was a death that involved an end-of-life decision, life was shortened by less than one week
• UK doctors are more likely than doctors in some countries to discuss end-of-life decisions with patients, patients' relatives and their medical and nursing colleagues
• 70% of end-of-life decision deaths involved discussions with patients and / or relatives
• 52% of ELD deaths involved discussions with medical colleagues
• 47% of ELD deaths involved discussions with nursing colleagues


The results also show that:

• Compared with other countries:
o UK doctors are more likely to discuss ELDs with colleagues
o UK doctors are cautious about taking decisions that significantly shorten life.

• Compared with countries where euthanasia or assisted suicide are permitted
o UK doctors are less likely to discuss ELDs with patients and patients' relatives.

• Compared with countries where euthanasia or assisted suicide are not permitted
o UK doctors are more likely to discuss ELDs with patients and patients' relatives.

Speaking about the research findings, Prof. Seale says:

“The cautiousness of UK doctors about shortening life, and the relatively high concern to discuss decisions with colleagues, indicates a tradition of sharing responsibility for these difficult decisions, coupled with a heightened awareness of potential scrutiny of decisions by others. There is a long standing commitment in UK medical culture to shared decision-making and palliative care, and this may explain why UK doctors are more willing than doctors in other non-permissive countries to discuss end-of-life decisions with patients and relatives.

One of the doctors surveyed provided a clear example of a fully shared end-of-life decision. The patient, her daughter and the haematologist decided together that no further transfusions would be given, as the patient's quality of life was so poor. She passed away within a week.

It is important not to confuse end-of-life decisions with voluntary euthanasia. End-of-life decisions are usually made as a part of normal medical and nursing practice that is devoted to providing good care. Active and intentional termination of another person's life is morally and legally different to withdrawal of treatment.“

Geoff Hanks, Editor, Palliative Medicine says:

"Prof. Seale's previous paper on end-of-life decisions, published in Palliative Medicine earlier this year, was very welcome. The research has made an important contribution to debates about euthanasia and assisted suicide, as well as throwing light on what happens in the care of people towards the end of life."

To view the paper, please visit: http://pmj.sagepub.com

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