Abstract
In 2015, the major critical care societies issued guidelines outlining a procedural approach to resolving intractable conflict between healthcare professionals and surrogates over life-sustaining treatments (LST). We report our experience with a resolving conflict procedure. This was a retrospective, single-centre cohort study of ethics consultations involving intractable conflict over LST. The resolving conflict process was initiated eleven times for ten patients over 2,015 ethics consultations from 2000 to 2020. In all cases, the ethics committee recommended withdrawal of the contested LST. In seven cases, the patient died or was transferred or a legal injunction was obtained before completion of the process. In the four cases in which LST was withdrawn, the time from ethics consultation to withdrawal of LST was 24.8 ± 12.2 days. Healthcare provider and surrogate were often distressed during the process, sometimes resulting in escalation of conflict and legal action. In some cases, however, surrogates appeared relieved that they did not have to make the final decision regarding LST. Challenges regarding implementation included the time needed for process completion and limited usefulness in emergent situations. Although it is feasible to implement a due process approach to conflict over LST, there are factors that limit the procedure’s usefulness.
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The dataset genereated and analyzed for the current study is not publically available due to patient confidentiality and privacy protections.
Notes
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In the Matter of Barbara Howe. 2005. Docket 3, P1255 (Commonwealth of Massachusetts Probate and Family Court Department).
In the Matter of Barbara Howe. 2005. Docket 3, P1255 (Commonwealth of Massachusetts Probate and Family Court Department).
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Rubin, E.B., Robinson, E.M., Cremens, M.C. et al. Declining to Provide or Continue Requested Life-Sustaining Treatment: Experience With a Hospital Resolving Conflict Policy. Bioethical Inquiry 20, 457–466 (2023). https://doi.org/10.1007/s11673-023-10270-7
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DOI: https://doi.org/10.1007/s11673-023-10270-7