Understanding and applying alternative dispute resolution methods in modern medical conflicts

Liang, Bryan A.

doi:10.1080/01947649809511069

Cited by 11 publications

(1 citation statement)

References 15 publications

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“…3 Of course, it is highly desirable to have providers able to address conflict in end-of-life circumstances if that is indeed possible. Although the authors do indicate that some cases are not amenable to negotiations, bioethics committee proceedings, anecdotal experiences, and other daily events in hospitals would indicate that most families are simply not willing to calmly and rationally sit down and negotiate care with a provider for a loved one at the end of life.…”

Section: Commentmentioning

confidence: 99%

Simple Changes Can Improve Conduct of End-of-Life Care in the Intensive Care Unit

&NA;

2005

Survey of Anesthesiology

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Section: Commentmentioning

confidence: 99%

Simple Changes Can Improve Conduct of End-of-Life Care in the Intensive Care Unit

&NA;

2005

Survey of Anesthesiology

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Seven Legal Barriers to End-of-Life Care<SUBTITLE>Myths, Realities, and Grains of Truth</SUBTITLE>

Meisel

Snyder

Quill³

2000

JAMA

167

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Legal myths about end-of-life care can undermine good care and ethical medical practice. In addition, at times ethics, clinical judgment, and the law conflict. Patients (or families) and physicians can find themselves considering clinical actions that are ethically appropriate, but raise legal concerns. The 7 major legal myths regarding end-of-life care are: (1) forgoing life-sustaining treatment for patients without decision-making capacity requires evidence that this was the patient's actual wish; (2) withholding or withdrawing of artificial fluids and nutrition from terminally ill or permanently unconscious patients is illegal; (3) risk management personnel must be consulted before life-sustaining medical treatment may be terminated; (4) advance directives must comply with specific forms, are not transferable between states, and govern all future treatment decisions; oral advance directives are unenforceable; (5) if a physician prescribes or administers high doses of medication to relieve pain or other discomfort in a terminally ill patient, resulting in death, he/she will be criminally prosecuted; (6) when a terminally ill patient's suffering is overwhelming despite palliative care, and he/she requests a hastened death, there are no legally permissible options to ease suffering; and (7) the 1997 Supreme Court decisions outlawed physician-assisted suicide. Many legal barriers to end-of-life care are more mythical than real, but sometimes there is a grain of truth. Physicians must know the law of the state in which they practice. JAMA. 2000;284:2495-2501.

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Dealing With Conflict in Caring for the Seriously Ill

Back¹,

Arnold²

2005

JAMA

109

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The Patient's StoryMrs B was an 84-year-old woman with advanced dementia who developed an aspiration pneumonia requiring an acute care hospital admission to the intensive care unit. During her recovery, she had difficulty during an informal swallowing study. To provide nutritional support, her family agreed to the temporary placement of a nasogastric tube, even though she pulled it out twice. Physical restraints were used to prevent further episodes of tube dislodgement. The hospital medical team recommended placement of a percutaneous gastrostomy for feeding. However, based on the patient's previous wish not to end up in the same state as a sister-in-law with Alzheimer dementia, her husband and the rest of her family believed that she would not have wanted a long-term feeding tube, and she was transferred to a nursing home without a feeding tube. The family's hope for her nursing home stay was for her to regain sufficient strength that she could resume oral intake. They were uncertain if rehospitalization would be appropriate at this point in her illness. PERSPECTIVESA Perspectives editor interviewed Mrs B's husband, Mr B, in December 2003, and the medical director of Mrs B's nursing home, Dr Q, in January 2004.MR B: My wife has been bedridden for the past 2 years and during that time has needed special care and caregivers since she has lost the use of both her arms and her legs. In March of 2003, she developed pneumonia, and we took her to the hospital. The doctors repeatedly suggested . . . inserting a gastric tube for nutrition. [This reminded me of] the story of my sister, who had had a gastric tube installed. She died a few years ago, and the quality of her life for years was just nonexistent. She was not really living, and the tube was all that kept her going. We were a little disturbed by the frequency of the calls for the gastric tube. [The doctors were] quite insistent. We indicated that it was just out of the question.DR Q: [When Mrs B was admitted], my understanding was that she was on a do-not-resuscitate status. But, if need be, [she] See also Patient Page.

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Understanding and applying alternative dispute resolution methods in modern medical conflicts

Cited by 11 publications

References 15 publications

Simple Changes Can Improve Conduct of End-of-Life Care in the Intensive Care Unit

Simple Changes Can Improve Conduct of End-of-Life Care in the Intensive Care Unit

Seven Legal Barriers to End-of-Life Care<SUBTITLE>Myths, Realities, and Grains of Truth</SUBTITLE>

Dealing With Conflict in Caring for the Seriously Ill

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