Ethics-Governance: Article: eMJA: Hunt , Intention, the law, and clinical decision-making in terminal care

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eMJA: Hunt , Intention, the law, and clinical decision-making in terminal care Death and the Physician. Intention, the law, and clinical decision-making in terminal care The duty of doctors is to strive to satisfy the wishes and interests of their patients and their patients' loved ones MJA 2001; 175: 516 The criminal law governing medical decision-making about the end of life is based on the doctor's intention. If the intention of treatment is to hasten or bring about the patient's death, whether by withdrawal of life-prolonging treatment, by administration of terminal sedation or a lethal bolus injection, the doctor could be prosecuted for murder. The survey of attitudes and practices of general surgeons in Australia by Douglas and colleagues in this issue of the Journal highlights some of the problems with using "intention" as the key factor for determining the moral and legal status of medical acts. Of the survey respondents, 36% indicated that, for the purpose of relieving a patient's suffering, they had given drugs "in doses greater than those required to relieve symptoms, with the intention of hastening death".1 This type of intervention has been referred to as "slow euthanasia".2,3 Theoretically, if the existing criminal code could be unswervingly applied, the survey findings suggest that many general surgeons in Australia could be prosecuted for murder, and possibly imprisoned, because of their care of terminally ill patients! In South Australia, the Consent to Medical Treatment and Palliative Care Act 1995 states: A medical practitioner responsible for the treatment or care of a patient in the terminal stage of a terminal illness . . . incurs no civil or criminal liability by administering medical treatment with the intention of relieving pain or distress . . . even though an incidental effect of the treatment is to hasten the death of the patient.4 The Act acknowledges the special context of a therapeutic clinical relationship, and affords some protection to clinicians who palliate terminal suffering. Full Article: http://www.mja.com.au/public/issues/175_10_191101/hunt/hunt.html


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