A perfect storm: fear of litigation for end of life care

Mitchell, Geoffrey K; Willmott, Lindy; White, Ben P; Piper, Donella; Currow, David C; Yates, Patsy M

doi:10.5694/mja2.50164

Topics

Palliative care

Ethics and law

Substance‐related disorders

Should doctors fear legal sanction for using opioids at the end of life?

A perfect storm arises from a rare confluence of adverse meteorological factors, and is a metaphor for an especially bad situation caused by a combination of unfavourable circumstances (www.oed.com). Health care at the end of life has been significantly disturbed by two converging fronts. The first is very public conversations relating to opioid overuse. The second is the current tension between standard end‐of‐life care and voluntary assisted suicide.

1 University of Queensland, Brisbane, QLD
2 Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD
3 University of New England, Armidale, NSW
4 University of Technology Sydney, Sydney, NSW
5 Queensland University of Technology, Brisbane, QLD

Correspondence: G.Mitchell@uq.edu.au

Acknowledgements:

This study was funded through the National Health and Medical Research Council (APP1061254).

Competing interests:

No relevant disclosures.

1. Roxburgh A, Hall WD, Dobbins T, et al. Trends in heroin and pharmaceutical opioid overdose deaths in Australia. Drug Alcohol Depend 2017; 179: 291–298.
2. Royal Australian College of General Practitioners. Government to warn almost 5000 GPs over high rates of opioid prescribing. Melbourne: RACGP, 2018. https://www1.racgp.org.au/newsGP/Professional/Government-to-warn-almost-5000-GPs-over-high-rates (viewed Apr 2019).
3. Royal Australian College of General Practitioners. GPs pulling back from palliative care over opioid crackdown fears. Melbourne: RACGP, 2018. https://www1.racgp.org.au/newsGP/Professional/GPs-pulling-back-from-palliative-care-over-opioid (viewed Apr 2019).
4. Gardiner C, Gott M, Ingleton C, et al. Attitudes of health care professionals to opioid prescribing in end‐of‐life care: a qualitative focus group study. J Pain Symptom Manage 2012; 44: 206–214.
5. Australian Pain Management Association. National pain strategy: pain management for all Australians. Sydney: APMA, 2010. https://www.painaustralia.org.au/improving-policy/national-pain-strategy (viewed Apr 2019).
6. Government of Western Australia. Government to introduce Bill to legalise voluntary assisted dying and improve end‐of‐life choices for Western Australians. Perth: Government of Western Australia, 2018. https://www.mediastatements.wa.gov.au/Pages/McGowan/2018/11/Government-to-introduce-Bill-to-legalise-voluntary-assisted-dying-and-improve-end-of-life-choices-for-Western-Australians.aspx (viewed Apr 2019).
7. Sulmasy DP. The last low whispers of our dead: when is it ethically justifiable to render a patient unconscious until death? Theor Med Bioeth 2018; 39: 233–263.
8. Curlin FA. Palliative sedation: clinical context and ethical questions. Theor Med Bioeth 2018; 39: 197–209.
9. Willmott L, White B, Piper D, et al. Providing palliative care at the end of life: should health professionals fear regulation? J Law Med 2018; 26: 214–245.

Online responses are no longer available. Please refer to our instructions for authors page for more information.