Maltese doctors and their views on end of life issues

Abstract

BACKGROUND: End-of-life (EoL) decisions are challenging for doctors. They involve legal and ethical dilemmas, coupled with personal values. In 2016, a local study was carried out on the views of doctors on some EoL decisions. This study is a follow-up study, with a greater focus on advance care planning and related issues, which were not sufficiently addressed in the first study.

METHODS: A mixed methods approach was used. An online questionnaire was distributed electronically to doctors and collected: demographic details of participants; the philosophy of life of the individual; training needs in palliative care; personal views and experiences on particular EoL issues. The necessary ethics approval and organizational approvals were obtained.

RESULTS: 195 doctors replied giving a response rate of 15.1%. Hence, caution needs to be applied in interpreting the data, despite a positive non-responder analysis. 142 doctors [72.8% (95%CI 66-78.9)] felt the need of further training in EoL care. For withdrawal/withholding of treatment, 129 doctors (66.1% (95%CI 59-72.8)) did not feel safeguarded. In the case of the doctrine of double effect for treatment intensification, 129 doctors [66.1% (95%CI 59-72.8)] did not feel safeguarded, whilst for advance care planning 122 doctors [62.5% (95%CI 55.4-69.4)] did not feel safeguarded. Issuing a DNR order was the least concerning since 103 doctors [52.8% (95%CI 45.1-59.5)] did not feel safeguarded in this regard.

CONCLUSION: Despite agreeing with various EoL practices, most doctors felt they were not medico-legally safeguarded and welcomed further training in EoL care.