End-of-life decision-making in a health services setting: An access to justice lens

This article uses an access to justice lens to draw links between the diffuse body of bioethics, health services and legal literature about end-of-life decisions and decision-making in a health services setting. It establishes that effective conflict engagement can be beneficial and conflict avoidance strategies, including ones commonly used by health professionals, detrimental. It also reveals factors that may affect the ability of parties to participate in end-of-life decision-making. First, formal law has a variable and fragmented role. This diminished role for law may impede the capacity of family members to overcome the significant knowledge/information power differential with health professionals. Secondly, effective communication with health professionals is critical to family member participation. Based on these findings, this article recommends training for health professionals regarding conflict, communication and power differentials. Further, it is argued appropriate information and advice about formal law is needed, particularly for those from disadvantaged socio-economic backgrounds.