Copyright (c) 2007 Ohio State Journal on Dispute Resolution
Ohio State Journal on Dispute Resolution
ARTICLE: Conflict Resolution at End-of-Life Relative to Life Support
Symposium Issue, 2007
23 Ohio St. J. on Disp. Resol. 89
Sharon Douglas, M.D.*
End-of-life issues are indeed some of the most difficult and powerful in healthcare.These issues must be approached carefully and appropriately.Conflict in end-of-life healthcare is not uncommon. There is often misunderstanding, mistrust, lack of education, miscommunication, and confusion among the participants in such decisions. Healthcare providers must recognize the importance of conflict resolution in the provision of care at the end of life. Such resolution requires participation of the patient, when able, surrogates, and healthcare providers of multiple disciplinary backgrounds.
According to the Code of Medical Ethics of the American Medical Association's Council on Ethical and Judicial Affairs' Opinion 2.20, "[l]ife-sustaining treatment is any treatment that serves to prolong life without reversing the underlying medical condition." 1 The Council on Ethical and Judicial Affairs' opinion goes on to say that "[l]ife-sustaining treatment may include, but is not limited to, mechanical ventilation, renal dialysis, chemotherapy, antibiotics, and artificial nutrition and hydration." 2 Wide use of life-sustaining treatments began in the United States in the 1960s and 1970s. 3
Withholding and withdrawing life-sustaining therapies are actions through which medical interventions are either not given or are removed from patients. 4 In intensive care units in the United States, most patient deaths follow a decision to stop, withdraw, or not start, withhold, life-sustaining treatments. 5 Medical ethical principles of autonomy, beneficence, and nonmaleficence support such actions. 6 No ethical distinction is made between withholding and withdrawing life support. 7 These actions are also legally supported by principles ...
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