Continuous, open communication is key to building trust and preventing conflict
Providers should seek to understand each patient’s life outside the context of illness including understanding their values, hopes, and fears and how these relate to goals of care
Providers should refrain from prematurely labeling interventions as futile or using this as justification for withholding or withdrawing care. Instead, they should first ensure a clear understanding of the patient’s medical goals and elicit input from relevant specialists to ensure a clear understanding of the clinical situation
Teams should involve communication experts, such as palliative care providers or hospital ethics committees, when faced with conflict around appropriate care
Institutions should have policies regarding conscientious objections. These should ensure that conscientious objections do not impede timely patient care or create excessive hardship for members of the medical team
References
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Judge rejects request by doctors to remove a patient’s respirator. New York Times. July 2, 1991. http://www.nytimes.com/1991/07/02/us/judge-rejects-request-by-doctors-to-remove-a-patient-s-respirator.html. Accessed 21 Apr 2016.
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American Thoracic Society. Withholding and withdrawing life-sustaining therapy. Ann Intern Med. 1991;115(6):478–85.CrossRef
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Danis M, Truog R, Devita M, et al. Consensus statement of the Critical Care Medicine’s Ethics Committee regarding futile and other possibly inadvisable treatments. Crit Care Med. 1997;25(5):887–91.CrossRef
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Rao JK, Anderson LA, Lin FC, Laux JP. Completion of advanced directives among U.S. consumers. Am J Prev Med. 2014;46(1):65–70.CrossRefPubMedPubMedCentral