Declining to Provide or Continue Requested Life-Sustaining Treatment: Experience With a Hospital Resolving Conflict...

Area of Science:

• Medical Ethics
• Critical Care Medicine
• Healthcare Conflict Resolution

Background:

• Guidelines for resolving intractable conflicts over life-sustaining treatments (LST) were issued in 2015.
• Intractable conflict between healthcare professionals and surrogates regarding LST requires a structured resolution process.

Purpose of the Study:

• To report the experience and evaluate the feasibility of a procedural approach to resolving intractable conflict over LST.
• To assess the challenges and outcomes associated with implementing a conflict resolution procedure for LST.

Main Methods:

• Retrospective, single-centre cohort study of ethics consultations.
• Analysis of cases involving intractable conflict over LST from 2000 to 2020.
• Review of the procedural approach to conflict resolution and its outcomes.

Main Results:

• The conflict resolution process was initiated 11 times for 10 patients.
• Ethics committees recommended LST withdrawal in all cases.
• LST withdrawal took a mean of 24.8 days; 7 cases did not reach completion due to patient death, transfer, or legal injunctions.
• The process caused distress and sometimes legal action, but some surrogates felt relieved.
• Implementation challenges included time consumption and limited utility in emergencies.

Conclusions:

• Implementing a due process approach for LST conflict is feasible.
• Factors such as time, potential for conflict escalation, and emergent situations limit the procedure's usefulness.
• The procedural approach offers a structured method but requires careful consideration of its practical limitations.