Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-76fb5796d-22dnz Total loading time: 0 Render date: 2024-04-29T00:09:50.908Z Has data issue: false hasContentIssue false

12 - Conflict in the healthcare setting at the end of life

Published online by Cambridge University Press:  30 October 2009

By
Susan Dorr Goold ,
Brent C. Williams  and
Robert Arnold
Edited by
Peter A. Singer  and
A. M. Viens
Susan Dorr Goold
Affiliation:
Associate Professor University of Michigan, Ann Arbor
Brent C. Williams
Affiliation:
Associate Professor University of Michigan, Ann Arbor
Robert Arnold
Affiliation:
University of Pittsburgh, Pittsburgh, USA
Peter A. Singer
Affiliation:
University of Toronto
A. M. Viens
Affiliation:
University of Oxford
Get access

Summary

Mrs. K, an 82-year-old woman with moderate to severe Alzheimer's dementia, advanced heart failure, emphysema, and diabetes mellitus with neuropathy and nephropathy has just been readmitted with difficulty breathing, two days after being discharged to the care of her daughter. In the previous admission for the same problem, she was treated in the intensive care unit, narrowly avoiding intubation by the use of aggressive pulmonary toilet, antibiotics, and diuretics for possible pneumonia and congestive heart failure. Just after her second admission, the attending physician approached Mrs. K's daughter to discuss forgoing life-sustaining treatment. “In my opinion, if your mother should have a cardiac arrest, resuscitating her would be futile,” said Mrs. K's physician. The daughter reacted angrily and insisted that “everything be done,” because her mom is strong and can get better (as she has previously).

What is conflict in the healthcare setting at the end of life?

Conflict may be defined as disagreement between people when a decision must be made or an action taken. Healthcare providers encounter conflict in everyday practice, and one of the most difficult and distressing situations physicians face is conflict with family members over forgoing life-sustaining treatment. What should be a cooperative effort to achieve treatment goals turns into an exercise in frustration and distress.

Why is conflict in the healthcare setting at the end of life important?

In the hospital, death is routine to the caregivers, but not to patients and families.

Type
Chapter
Information
The Cambridge Textbook of Bioethics , pp. 78 - 84
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Christakis, N. A. and Lamont, E. B. (2000). Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study. BMJ 320: 469–73.CrossRefGoogle ScholarPubMed
Cruzan v. Director, Missouri Dep't. of Health [1990] 110 S. Ct. 2841.
Diem, S. J., Lantos, J. D., and Tulsky, J. A. (1996). Cardiopulmonary resuscitation on television. Miracles and misinformation. N Engl J Med 334: 1578–82.CrossRefGoogle ScholarPubMed
Fagerlin, A. and Schneider, C. E. (2004). Enough: the failure of the living will. Hastings Cent Rep 34: 30–42.CrossRefGoogle ScholarPubMed
Field, M. J. and Cassel, C. K., for the Committee on Care at the End of Life of the Institute of Medicine (1997). Approaching Death: Improving Care at the End of Life. Washington, DC: Institute of Medicine.Google Scholar
Fox, E., Landrum-McNiff, K., Zhon, Z., et al., for the SUPPORT Investigators (1999). Evaluation of prognostic criteria for determining hospice eligibility in patients with advanced lung, heart, or liver disease. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. JAMA 282: 1638–45.CrossRefGoogle ScholarPubMed
Gage, B., Miller, S. C., Coppola, K., et al., for the MEDSTAT Group (2000). Important Questions for Hospice in the Next Century. Washington, DC: Government Printing Office (http://aspe.hhs.gov/daltcp/Reports/impquesa.htm). Accessed 5 July 2006.Google Scholar
Goold, S. D. (2000). Conflicts of interest and obligation. In Ethics in Primary Care, ed. Sugarman, J.. New York: McGraw-Hill, pp. 93–101.Google Scholar
Kahneman, D., Slovic, P., and Tversky, A. (ed.) (1982). Judgement under Uncertainty: Heuristics and Biases. New York: Cambridge University Press.CrossRefGoogle Scholar
Knapp, P., Raynor, D. K., and Berry, D. C. (2004). Comparison of two methods of presenting risk information to patients about the side effects of medicines. Qual Safety Healthcare 13: 176–80.CrossRefGoogle ScholarPubMed
Kopelman, M. B., Ubel, P. A., and Engel, K. G. (2005). Changing times, changing opinions: history informing the family presence debate. Acad Emerg Med 12: 999–1002.CrossRefGoogle ScholarPubMed
Lynn, J., Vries, K. O., Arkes, H. R., et al. (2000). Ineffectiveness of the SUPPORT intervention: review of explanations. J Am Geriatr Soc 48(Suppl. 5): S206–13.CrossRefGoogle ScholarPubMed
Meier, D. E., Back, A. L., and Morrison, R. S. (2001). The inner life of physicians and care of the seriously ill. JAMA 286: 3007–14.CrossRefGoogle ScholarPubMed
Mildred, Z. and Solomon, M. Z. (2000). Institutional accountability in end of life care: organizational leadership, measurement, and consumer demand. J Palliat Med 3: 225–8.Google Scholar
Morrison, R. S. and Siu, A. L. (2000). Survival in end–stage dementia following acute illness. JAMA 284: 47–52.CrossRefGoogle ScholarPubMed
Novack, D. H., Suchman, A. L., Clark, W., et al. (1997). Calibrating the physician. Personal awareness and effective patient care. Working Group on Promoting Physician Personal Awareness, American Academy on Physician and Patient. JAMA 278: 502–9.CrossRefGoogle Scholar
Prendergast, T. J. (2001). Advance care planning: pitfalls, progress, promise. Critical Care Medicine 29(Suppl. 2): N34–9.CrossRefGoogle ScholarPubMed
Rosenczweig, C. (1998). Should relatives witness resuscitation: ethical issues and practical considerations. CMAJ 158: 617–20.Google ScholarPubMed
Scott, R. A., Aiken, L. H., Mechanic, D., and Moravcsik, J. (1995). Organizational aspects of caring. Milbank Quart 73: 77–95.CrossRefGoogle ScholarPubMed
Silveira, M. J., Goold, S. D., and McMahon, L. F. Jr. (2003). Access to hospice under Medicare; some for all, or all for some? J Gen Intern Med 18: 217.Google Scholar
Silveira, M. J., Kabeto, M., and Langa, K. M. (2005). Net worth predicts symptom burden for at the end of life. J Palliat Med 8: 827–37.CrossRefGoogle ScholarPubMed
Smith, R. C., Lyles, J. S., Mettler, J., et al. (1998). The effectiveness of intensive training for residents in interviewing. A randomized, controlled study. Ann Intern Med 128: 139–41.CrossRefGoogle ScholarPubMed
Spikes, J. and Holland, J. (1975). The physician's response to the dying patient. In Psychological Care of the Medically Ill: A Primer in Liaison Psychiatry ed. Strain, J. J. and Grossman, S.. New York: Appleton-Century-Crofts, pp. 138–48.Google Scholar
Tomlinson, T., Howe, K., Notman, M., and Rossmiller, D. (1990). An empirical study of proxy consent for elderly persons. Gerontologist 30: 54–64.CrossRefGoogle ScholarPubMed
Tulsky, J. A., Chesney, M. A., and Lo, , (1995). How do medical residents discuss resuscitation with patients?J Gen Intern Med 10: 436–42.CrossRefGoogle ScholarPubMed
Tulsky, J. A., Fischer, G. S., Rose, M. R., and Arnold, R. M. (1998). Opening the black box: how do physicians communicate about advance directives?Ann Intern Med 129: 441–9.CrossRefGoogle ScholarPubMed
Weissman, D. E. (2004). Decision making at a time of crisis near the end of life. JAMA 292: 1738–43.CrossRefGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×