Copyright (c) 2007 Ohio State Journal on Dispute Resolution
Ohio State Journal on Dispute Resolution
ARTICLE: The Emerging Culture of Health Care: Improving End-of-Life Care through Collaboration and Conflict Engagement Among Health Care Professionals
Symposium Issue, 2007
23 Ohio St. J. on Disp. Resol. 105
I. Factors for Improving End-of-life Care: An Overview
There are frequent calls for improving end-of-life care in the United States. In a recent Hastings Center special report, Murray and Jennings cite three areas that require rethinking of current assumptions regarding end-of-life care. These include greater attention to (1) the end-of-life care delivery system, (2) the approach to advance directives and surrogate decisionmaking, and (3) how we manage conflict and disagreement. 1
Conflict is common during end-of-life decisionmaking. In a 2001 study, conflict was identified by at least one member of the clinical team in 78% of 102 cases of intensive care unit patients who were determined to have a likelihood of having treatment withheld or withdrawn. 2 Conflict surrounding end-of-life care typically takes three forms: conflict among the patient's family members, between the family and the health care providers, and conflict that arises among the team members themselves. 3 According to Breen and her co-authors, conflict among staff was identified in 48% of these cases, between staff and family members in 48% of the cases, and among family members in 24% of the cases. 4
Conflict among family members who are tasked with decisionmaking on behalf of patients who are no longer able to decide for themselves is well documented and occasionally takes public focus, as in the unfortunate case of Terry Schiavo. 5 Disagreements between family members and health care providers are also common given the complex nature of defining futility within the emotional climate of grief and uncertainty ...
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