Resolving conflicts over end-of-life care: Mayo experts offer tips

November 27, 2012

It's one of the toughest questions patients and their loved ones can discuss with physicians: When is further medical treatment futile? The conversation can become even more difficult if patients or their families disagree with health care providers' recommendations on end-of-life care.

Early, clear communication between patients and their care teams, choosing objective surrogates to represent patients and involving third parties such as ethics committees can help avoid or resolve conflicts, Mayo Clinic experts Christopher Burkle, M.D., J.D., and Jeffre Benson, M.D., write in the November issue of .

" in the United States have struggled with the importance of maintaining while attempting to practice under the guidance of treatments based on beneficial care," Dr. Burkle, the study's lead author, says.

Tips from Drs. Burkle and Benson to effectively discuss end-of-life care include:

  • Clear communication: Early and clear communication between and patients or their surrogates is the best way to avoid over whether medical care should continue. Recent studies show that more than 95 percent of such disputes are resolved through mediated meetings involving physicians and patients/surrogates.
  • Choose objective surrogates if patients cannot represent themselves: The surrogate's role is to stand in the shoes of the patient and suppress his or her own judgment in favor of what the patient would have done. However, it is important to acknowledge that medical surrogates often struggle to balance their wishes for the patient with the patient's own wishes. Studies have found that not only do many surrogates fail to accurately predict a patient's treatment wishes, but when asked to resolve disputes, they are more likely to show bias by overestimating the patient's desire for continued treatment.
  • Involve third parties when necessary: When health care providers and patients or their advocates cannot agree on end-of-life care, involving a third party becomes necessary. Beginning in 1992, the Joint Commission, the largest hospital accreditation organization in the United States, required hospitals to establish procedures for considering ethical issues. Hospital-based ethics committees have been the most common response to this requirement.
"End-of-life care will continue to be an ongoing discussion within the medical community; however, it is important that providers and patients/medical surrogates continue to dialogue," Dr. Burkle says. "Only then can experts continue to offer insight into the effectiveness of systems used in countries that have moved to a more patient-centrist approach to end-of-life care treatment choices."

Explore further: Let's talk: The nature of the health care surrogate-clinician relationship

Related Stories

Let's talk: The nature of the health care surrogate-clinician relationship

August 8, 2012
A new study from the Regenstrief Institute and Indiana University School of Medicine examines the relationship between family members who make decisions for hospitalized older adults with impaired cognition and the doctors, ...

Mayo Clinic finds discussion of end-of-life care helps heart to patients and families

June 1, 2011
For patients with severe heart failure, an implanted mechanical pump known as a Left Ventricular Assist Device (LVAD) can be a life-sustaining treatment. Even though the technology involves risks, few patients and their families ...

Decision aid helps families, clinicians communicate about care decisions

May 16, 2011
Surrogate decision-makers faced with the difficult task of overseeing loved ones' medical care may find help thanks to a new decision aid aimed at patients with prolonged mechanical ventilation. According to a study conducted ...

Study demonstrates that earlier end of life care discussions are linked to less aggressive care in final days of life

November 13, 2012
A large population- and health systems-based prospective study reports earlier discussions about end of life (EOL) care preferences are strongly associated with less aggressive care in the last days of life and increased ...

Recommended for you

Sugar not so sweet for mental health

July 27, 2017
Sugar may be bad not only for your teeth and your waistline, but also your mental health, claimed a study Thursday that was met with scepticism by other experts.

Could insufficient sleep be adding centimeters to your waistline?

July 27, 2017
Adults in the UK who have poor sleep patterns are more likely to be overweight and obese and have poorer metabolic health, according to a new study.

Vitamin E-deficient embryos are cognitively impaired even after diet improves

July 27, 2017
Zebrafish deficient in vitamin E produce offspring beset by behavioral impairment and metabolic problems, new research at Oregon State University shows.

The role of dosage in assessing risk of hormone therapy for menopause

July 27, 2017
When it comes to assessing the risk of estrogen therapy for menopause, how the therapy is delivered—taking a pill versus wearing a patch on one's skin—doesn't affect risk or benefit, researchers at UCLA and elsewhere ...

Blowing smoke? E-cigarettes might help smokers quit

July 26, 2017
People who used e-cigarettes were more likely to kick the habit than those who didn't, a new study found.

Brain disease seen in most football players in large report

July 25, 2017
Research on 202 former football players found evidence of a brain disease linked to repeated head blows in nearly all of them, from athletes in the National Football League, college and even high school.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.