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Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association

The role of law in end-of-life decision-making in emergency departments and intensive care units: a retrospective review of current practice in a Queensland health service

Jayne Hewitt A B C * , Nemat Alsaba C D , Katya May A C , Colleen Cartwright E , Lindy Willmott F , Ben P. White F and Andrea P. Marshall A C
+ Author Affiliations
- Author Affiliations

A School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Qld 4222, Australia.

B Griffith University, Law Futures Centre, Gold Coast Campus, Parklands Drive, Southport, Qld 4222, Australia.

C Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Qld 4215, Australia.

D Faculty of Health Science and Medicine, Bond University, 14 University Drive, Robina, Qld 4226, Australia.

E Faculty of Health, Southern Cross University, Southern Cross Drive, Bilinga, Qld 4225, Australia.

F Faculty of Business and Law, Queensland University of Technology, Gardens Point campus, 2 George Street, Brisbane, Qld 4000, Australia.

* Correspondence to:

Australian Health Review 48(1) 95-102
Submitted: 18 August 2023  Accepted: 17 November 2023  Published: 12 December 2023

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.



There is limited evidence about how legal frameworks that underpin end-of-life decisions are applied in practice. This study aimed to identify how end-of-life decisions are made and documented in emergency departments and intensive care units. The secondary aim was to explore the extent to which the legal processes featured in these decisions.


A retrospective chart audit of 85 adult patients who died in the emergency departments and intensive care units of a Queensland health service was undertaken. Quantitative data were analysed and reported using descriptive statistics. Qualitative textual data were analysed using inductive content analysis.


Nearly all admissions were unplanned (97.6%), and most patients (74.1%) were admitted from home. Only one patient had an advance health directive, although all had an eligible substitute decision-maker. The qualitative analysis revealed two main concepts – ‘healthcare professionals choreograph the end of life’ and ‘patients and families are carried on an unplanned journey’.


There was limited documentation related to the application of the legal framework in these decisions. Healthcare professionals relied on their clinical judgment about what was in the best interest of the patient. It was common for there to be a substantial effort to achieve consensus in decision-making which coincidently complied with the law.

Keywords: advance health directive, end-of-life care, end-of-life decision-making, health law, healthcare documentation, medical record audit, substitute decision-makers, withholding treatment.


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