Doctors can be “deeply conflicted” and sometimes struggle to comply with a patient’s end-of-life plans, especially if they feel the condition is treatable or they doubt the directive’s validity, an Australian study shows. 

The Victorian researchers say that hospital specialists are motivated most by a patient’s best interests, ahead of respecting their autonomy, when making medical decisions based on advance care directives (ACDs).

“Doctors tended to rely on their own clinical judgement to make treatment decisions, sometimes overriding the ACD on the basis that the treatments requested were ‘unreasonable’, ‘futile’ or that the patients’ condition was potentially ‘reversible’,” they wrote in the BMJ Open. 

The researchers interviewed 21 doctors from a variety of specialties at a Melbourne hospital after presenting them with three case vignettes to explore how doctors used ACDs to guide treatment decisions.