Se frayer un chemin entre désaccords et conflits dans le contexte d’une définition cérébrale du décès

Abstract

In this paper, we discuss situations in which disagreement or conflict arises in the critical care setting in relation to the determination of death by neurologic criteria, including the removal of ventilation and other somatic support. Given the significance of declaring a person dead for all involved, an overarching goal is to resolve disagreement or conflict in ways that are respectful and, if possible, relationship preserving. We describe four different categories of reasons for these disagreements or conflicts: 1) grief, unexpected events, and needing time to process these events; 2) misunderstanding; 3) loss of trust; and 4) religious, spiritual, or philosophical differences. Relevant aspects of the critical care setting are also identified and discussed. We propose several strategies for navigating these situations, appreciating that these may be tailored for a given care context and that multiple strategies may be helpfully used. We recommend that health institutions develop policies that outline the process and steps involved in addressing situations where there is ongoing or escalating conflict. These policies should include input from a broad range of stakeholders, including patients and families, as part of their development and review.

Relever les défis mondiaux liés à la détermination du décès : le leadership canadien en matière de création de consensus

“…Specific papers highlight the strengths and limitations of current guidance, evidence, research, and practice in the determination of death for both adults and young children. [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] Of equal importance are papers exploring family and societal understanding and acceptance of death determination criteria, [61][62][63][64] and the implications of a brain-based definition of death from a legal and cultural perspective. [65][66][67] Conclusion Some phenomena move forward with time, some do not.…”

“…Cette collection aidera a `re ´pondre aux de ´fis mondiaux et propres au Canada en matie `re de de ´termination du de ´ce `s. Certains articles spe ´cifiques soulignent les forces et les limites des lignes directrices, des donne ´es probantes, de la recherche et de la pratique actuelles dans la de ´termination du de ´ce `s chez les adultes et les jeunes enfants. [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] Tout aussi importants sont les articles explorant la compre ´hension et l'acceptation par la famille et la socie ´te ´des crite `res de de ´termination du de ´ce `s, [61][62][63][64] ou encore les implications d'une de ´finition ce ´re ´brale du de ´ce `s d'un point de vue juridique et culturel. [65][66][67]…”