UK end-of-life care ‘focusing on choice at the expense of guidance’

A new University of Cambridge study has suggested that UK doctors may be becoming too concerned with giving patients choice over their end-of-life care, even when it is not in the patient's best interest.

The interview study of 58 doctors and trainees at three academic medical centres in the US and one in the UK shows a difference between experienced doctors and trainees with regard to do not resuscitate (DNR) orders.

While veteran doctors across all hospitals were willing to make recommendations against resuscitation if they believed it would be futile, trainees often felt compelled to offer the choice of resuscitation in a neutral way, even in cases where they believed it would be inappropriate.

The culture of the hospital in question affected doctors' willingness to discourage the ineffective use of CPR in futile situations, such as for frail elderly patients with incurable cancer, for whom resuscitation can result in injury and prolonged suffering.

Elizabeth Dzeng, a PhD student at the University of Cambridge and a practising doctor at the Johns Hopkins School of Medicine, said that in many cases, patients are overwhelmed by the choices on offer and do not actually want to make the decision themselves.

She added: "Perhaps policies more oriented towards best interest decision-making might allow physicians the space to shift their focus from a discourse of choice to that of care."