Relias Media - Continuing Medical Education Publishing

The trusted source for

healthcare information and

CONTINUING EDUCATION.

  • Sign In
  • Sign Out
  • MyAHC
    • Home
      • Home
      • Newsletters
      • Blogs
      • Archives
      • CME/CE Map
      • Shop
    • Emergency
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • Hospital
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • Clinical
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • All Access
      • Subscribe Now
      • My Subscription
    • My Account
      • My Subscriptions
      • My Content
      • My Orders
      • My CME/CE
      • My Transcript
    Home » Clinicians face pressure to "keep going"

    Clinicians face pressure to "keep going"

    September 1, 2013
    No Comments
    Reprints
    Facebook Twitter Linkedin Share Share

    Related Articles

    Continuity plans keep IRBs going in hard times

    Healthcare Infection Prevention-Will outpatient pressure outpace antibiotic efficacy? Clinicians try to nix RX in ambulatory settings

    The ‘Parallel Pandemic’: Clinicians May Face Post-Traumatic Stress

    Related Products

    Hospital Infection Prevention-The day-care connection to drug resistance: Parental pressure leads to antibiotic pressure | Single Article

    Face-to-face CM is key to HIV-AIDS program | Single Article

    Face-to-face interventions help chronically ill | Single Article

    Keywords

    ethics

    Clinicians face pressure to "keep going"

    Disagreements are barriers to treatment abatement

    Clinicians may face pressure from family members to "keep going" when there is concern that the patient might not have wanted aggressive end-of-life interventions, or the health care team considers palliation in the patient’s best interests. "This is very common," says Nancy M. P. King, JD, co-director of the Center for Bioethics, Health, & Society and Graduate Program in Bioethics at Wake Forest University in Winston-Salem, NC.

    Failures of communication are often at the root of these disagreements. "This probably accounts for the majority of ethics consultations in many health care facilities," says King. "It is less common for families to know that the patient’s advance directive requests treatment abatement and nonetheless seek to override those end-of-life wishes, but it certainly occurs."

    Usually, this isn’t because families disagree with the patient’s wishes, however. More often, families misunderstand or resist understanding the patient’s condition, argue that the patient would have made a different decision about his or her current circumstances, or misunderstand the chosen health care agent’s decision-making authority or the meaning of substituted judgment."Family members’ grief and guilt are often barriers to treatment abatement that may manifest as simple disagreements," says King. She recommends these approaches:

    • The health care facility should have a continual process of education for clinicians and legal counsel about advance directives, advance care planning, and end-of-life decisions.

    Clinicians who understand their facilities’ policies and the applicable law are more likely to seek consultation, and less likely to override advance directives. "Legal over-caution is often the reason for listening to the family rather than following the patient’s wishes, but that over-caution is rarely justified," says King.

    • The team should identify and support the patient’s named agent.

    "This is as important as identifying the patient’s wishes," says King. "Support and counseling for the family is equally essential in every instance." Families need to know that their acquiescence with the patient’s wishes is neither "giving up" nor "killing" a loved one.

    Even when patients have informed families of their wishes, that discussion may not have been enough to reassure the family about honoring those wishes. "Additional supportive counseling may help," King suggests.

    • The team needs to know that they have an absolute duty to provide aggressive palliative care to patients in these circumstances, regardless of family objections.

    This is especially important if the decision-making process is contested or resolution of the conflict is delayed, even if the facility ultimately supports the family’s choices. "Patients must be kept comfortable, no matter what else is in the treatment plan," says King. 

    SOURCE

    Nancy M. P. King, JD, Co-Director, Center for Bioethics, Health, & Society/Graduate Program in Bioethics, Wake Forest University, Winston-Salem, NC. Phone: (336) 716-4289. E-mail: nmpking@wakehealth.edu.

    Post a comment to this article

    Report Abusive Comment

    www.reliasmedia.com

    Medical Ethics Advisor

    View PDF
    Medical Ethics Advisor 2013-09-01
    September 1, 2013

    Table Of Contents

    Is there a conflict over patient’s wishes? Involve clinical ethicists!

    Clinicians face pressure to "keep going"

    As physician incentives grow, so do ethical concerns

    "Big data" in health care raises some ethical concerns

    Unintended consequences are possible with genetic screening

    Ethical issues involving medical use of marijuana

    Begin Test
    Buy this Issue/Course

    Shop Now: Search Products

    • Subscription Publications
    • Books & Study Guides
    • Webinars
    • Group & Site
      Licenses
    • State CME/CE
      Requirements

    Webinars And Events

    View All Events
    • Home
      • Home
      • Newsletters
      • Blogs
      • Archives
      • CME/CE Map
      • Shop
    • Emergency
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • Hospital
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • Clinical
      • All Products
      • Publications
      • Study Guides
      • Webinars
      • Group Sales
    • All Access
      • Subscribe Now
      • My Subscription
    • My Account
      • My Subscriptions
      • My Content
      • My Orders
      • My CME/CE
      • My Transcript
    • Help
    • Search
    • About Us
    • Sign In
    • Register
    Relias Media - Continuing Medical Education Publishing

    The trusted source for

    healthcare information and

    CONTINUING EDUCATION.

    Customer Service

    customerservice@reliasmedia.com

    U.S. and Canada: 1-800-688-2421

    International +1-404-262-5476

    Accounts Receivable

    1-800-370-9210
    ReliasMedia_AR@reliasmedia.com

    Mailing Address

    • 1010 Sync St., Suite 100
      Morrisville, NC 27560-5468
      USA

    © 2021 Relias. All rights reserved.

    Do Not Sell My Personal Information  Privacy Policy  Terms of Use  Contact Us  Reprints  Group Sales

    For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, DPO@relias.com

    Design, CMS, Hosting & Web Development :: ePublishing