End-of-life healthcare decisions are always difficult — for patients, loved ones, and doctors alike. But they are even more complicated when disagreements arise over the question of when medical treatment is futile.
In an effort to resolve conflicts and help patients, families, and physicians grapple with the many questions in end-of-life care, Mayo Clinic experts have devised a series of guidelines to improve communication and avoid or resolve conflicts.
"Healthcare professionals in the United States have struggled with the importance of maintaining patient autonomy while attempting to practice under the guidance of treatments based on beneficial care," noted Dr. Christopher Burkle, who detailed the guidelines with colleague Dr. Jeffre Benson in the journal Mayo Clinic Proceedings.
Among the pair’s recommendations for managing end-of-life care decisions:
• Clear communication: Early and clear communication between healthcare providers and patients or their surrogates can avoid disagreement over whether medical care should continue. Studies show that more than 95 percent of such disputes are resolved through mediated meetings involving physicians, patients, and surrogates.
• Choose objective advocates or surrogates if patients cannot represent themselves: The person's role is to choose what the patient would have done for himself or herself.
• Involve third parties when necessary: When healthcare providers and patients or their advocates cannot agree on end-of-life care, it may be necessary to involve a third party, such as a hospital-based ethics committee.
"End-of-life care will continue to be an ongoing discussion within the medical community; however, it is important that medical care providers and patients/medical surrogates continue to dialogue," Burkle said. "Only then can experts continue to offer insight into the effectiveness of systems used in countries that have moved to a more patient-centrist approach to end-of-life care treatment choices."