Withholding life prolonging treatment, and self deception.

Area of Science:

• Medical Ethics
• Geriatric Medicine
• General Practice

Background:

• Non-treatment decisions in terminal illness are complex.
• Understanding physician reasoning is crucial for ethical care.

Purpose of the Study:

• Compare non-treatment decision-making between general practitioners (GPs) and geriatricians.
• Investigate the influence of ethical or legal reasoning on these decisions.

Main Methods:

• Qualitative study involving interviews with consultant geriatricians and randomly selected GPs.
• Doctors responded to five patient vignettes regarding hospital admission for further care.
• Explored factors influencing decisions, including consultation, responsibility, and family preferences.

Main Results:

• High concordance in decisions between GPs and geriatricians.
• Medical reasons primarily explained decisions; ethical/legal reasoning was minimal.
• Relatives' wishes were influential, but resource considerations were not.
• Ten percent would provide life-prolonging treatment for severe brain damage.

Conclusions:

• Decision-making often lacked explicit ethical or legal grounding.
• Potential non-recognition or denial of ethical consequences of withholding treatment.
• Decision-making processes may involve conscious or unconscious deception regarding end-of-life care.