title: Palliative care and other physicians' knowledge, attitudes and practice relating to the law on withholding/withdrawing life-sustaining treatment: Survey results.
abstract: BACKGROUND
  To effectively care for people who are terminally ill, including those without decision-making capacity, palliative care physicians must know and understand the legal standing of Advance Care Planning in their jurisdiction of practice. This includes the use of advance directives/living wills and substitute decision-makers who can legally consent to or refuse treatment if there is no valid advance directive.
  
  
  OBJECTIVE
  This study aimed to investigate the knowledge, attitudes and practices of medical specialists most often involved in end-of-life care in relation to the law on withholding/withdrawing life-sustaining treatment from adults without decision-making capacity.
  
  
  METHODS
  A pre-piloted survey was posted to specialists in palliative, emergency, geriatric, renal and respiratory medicine; intensive care; and medical oncology in three Australian States. Surveys were analysed using SPSS 20 and SAS 9.3.
  
  
  RESULTS
  The overall response rate was 32% (867/2702) - 52% from palliative care specialists. Palliative care specialists and geriatricians had significantly more positive attitudes towards the law (χ42(2) = 94.352; p < 0.001) and higher levels of knowledge about the withholding/withdrawing life-sustaining treatment law (χ7(2) = 30.033; p < 0.001) than did the other specialists, while still having critical gaps in their knowledge.
  
  
  CONCLUSIONS
  A high level of knowledge of the law is essential to ensure that patients' wishes and decisions, expressed through Advance Care Planning, are respected to the maximum extent possible within the law, thereby according with the principles and philosophy of palliative care. It is also essential to protect health professionals from legal action resulting from unauthorised provision or cessation of treatment.
authors.affiliation: ASLaRC Aged Services Unit, Southern Cross University, Gold Coast, QLD, Australia Cartwright Consulting Australia, Miami, QLD, Australia colleen.cartwright@scu.edu.au.
authors.forename: Colleen Maria
authors.initials: CM
authors.lastname: Cartwright
authors.affiliation: Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia.
authors.forename: Ben P
authors.initials: BP
authors.lastname: White
authors.affiliation: Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia.
authors.forename: Lindy
authors.initials: L
authors.lastname: Willmott
authors.affiliation: School of Population Health, The University of Queensland, Brisbane, QLD, Australia.
authors.forename: Gail
authors.initials: G
authors.lastname: Williams
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
authors.forename: Malcolm Holbrook
authors.initials: MH
authors.lastname: Parker
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000331:legislation & jurisprudence*; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001315:Australia; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008020:Life Support Care / Q000331:legislation & jurisprudence*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000331:legislation & jurisprudence*; D013727:Terminal Care / Q000331:legislation & jurisprudence*; D028761:Withholding Treatment / Q000331:legislation & jurisprudence*
keywords: Advance healthcare planning; law; palliative care; treatment refusal; withdrawing/withholding life-sustaining treatment