title: Law, ethics and clinical judgment in end-of-life decisions--how do Norwegian doctors think?
abstract: OBJECTIVE
  According to Norwegian law, an autonomous patient has the right to refuse life-prolonging treatment. If the patient is not defined as dying, however, health personnel are obliged to instigate life-saving treatment in an emergency situation even against the patient's wishes. The purpose of this study was to investigate how doctors' attitudes and knowledge agree with these legal provisions, and how the statutory provision on emergency situations influences the principle of patient autonomy for severely ill, but not dying, patients.
  
  
  METHODS
  A strategic sample of 1175 Norwegian doctors who are specialists in internal medicine, paediatrics, surgery, neurology and neurosurgery received a mail questionnaire about decisions on end-of-life care in hypothetical scenarios. The case presented concerns a 45-year-old autonomous patient diagnosed with end-stage ALS who declines ventilatory treatment. Recipients were randomly selected from the membership roster of the Norwegian Medical Association. 640 (54.5%) responded; of these, 406 had experience with end-of-life decisions.
  
  
  RESULTS
  56.1% (221/394) stated that ALS patients in such situations can always refuse life-prolonging treatment, and 42.4% (167/394) were of the opinion that the patient can normally refuse life-prolonging treatment. 1.5% (6/394) stated that the patient cannot refuse life-prolonging treatment.
  
  
  CONCLUSIONS
  The answers indicate that the respondents include patients' refusal in an overall clinical judgement, and interpret patients' right to decline life-saving treatment in different ways. This may reflect the complex legal situation in Norway regarding patient autonomy with respect to the right of severely ill, but not dying, patients' right to decline acute life-saving treatment.
authors.affiliation: Centre for Medical Ethics, Institute of General Practice and Community Medicine, University of Oslo, P.O. Box 1130 Blindern, NO-0318 Oslo, Norway. marbahus@online.no
authors.forename: Marianne K
authors.initials: MK
authors.lastname: Bahus
authors.forename: Petter Andreas
authors.initials: PA
authors.lastname: Steen
authors.forename: Reidun
authors.initials: R
authors.lastname: Førde
mesh_terms: D016223:Advance Directives / Q000941:ethics* / Q000331:legislation & jurisprudence*; D000690:Amyotrophic Lateral Sclerosis / Q000628:therapy; D001291:Attitude of Health Personnel; D003657:Decision Making; D006801:Humans; D007600:Judgment; D008020:Life Support Care / Q000941:ethics* / Q000331:legislation & jurisprudence*; D009664:Norway; D010820:Physicians; D011795:Surveys and Questionnaires