Managing Conflict at the End-of-Life
There are increasing pressures to admit patients to intensive care units (ICUs). The majority of people now die in institutions, rather than at home. Even terminally ill patients in nursing homes sometimes find their way into acute hospitals. Once in the emergency department, they are often assessed and admitted to hospital as the history and prognosis may not initially be clear; and because it is usually easier, in purely practical terms, to admit a terminally ill elderly patient rather than to arrange appropriate support in the community. Once in an acute hospital there are expectations, realistic or not, that there is some hope. The conveyor belt to intensive care is further facilitated by increasingly specialized physicians who often do not understand the way different co-morbidities and multiorgan involvement influences the patient’s prognosis.
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- 1.Miller DW Jnr, Miller CG (2005) On evidence, medical and legal. J Am Phys Surg 10: 70–75Google Scholar
- 5.Jones DA, McIntyre T, Baldwin I, Mercer I, Kattula A, Bellomo R (2007) The medical emergency team and end-of-life care: A pilot study. Crit Care Resus 9: 151–156Google Scholar
- 6.World Health Organization (2005) Preventing Chronic Diseases: A Vital Investment. WHO, GenevaGoogle Scholar
- 13.Committee on Bioethics, American Academy of Pediatrics (1994) Guidelines of foregoing life-sustaining treatment. Pediatrics 3: 532–536Google Scholar
- 14.Committee on Bioethics, American Academy of Pediatrics (1996) Ethics and the care of critically ill infants and children. Pediatrics 98: 149–152Google Scholar
- 18.British Medical Association Ethics Committee (1999) Withholding and Withdrawing Life-prolonging Medical Treatment. Guidance for Decision Making. BMJ Publishing Group, LondonGoogle Scholar
- 19.General Medical Council (2002) Withhold and Withdrawing Life-prolonging Treatments: Good Practice in Decision-Making. General Medical Council, LondonGoogle Scholar
- 28.General Medical Council (2008) Consent: patients and doctors making decisions together. Available at: http://www.gmc-uk.org/news/artides/Consent_guidance.pdf. Accessed Nov 208Google Scholar
- 30.American Lung Association, American Thoracic Society (1997) Official statement on the fair allocation of intensive care unit resources. Am J Respir Crit Care Med 156: 1282–1301Google Scholar
- 34.NSW Health Department (2005) Guidelines for End-Of-Life Care and Decision-Making. Better Health Centre. Publications Warehouse, GladesvilleGoogle Scholar
- 38.Faunce T (2005) Emerging roles for law and human rights in ethical conflicts surrounding neuro critical care. Crit Care Resus 7: 221–227Google Scholar