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23 Ohio St. J. on Disp. Resol. 105 (2007-2008)
The Emerging Culture of Health Care: Improving End-of-Life Care through Collaboration and Conflict Engagement among Health Care Professionals

handle is hein.journals/ohjdpr23 and id is 113 raw text is: The Emerging Culture of Health Care: Improving End-of-Life Care through Collaboration and Conflict Engagement Among Health Care Professionals DEBRA GERARDI* I. FACTORS FOR IMPROVING END-OF-LIFE CARE: AN OVERVIEW There are frequent calls for improving end-of-life care in the United States. In a recent Hastings Center special report, Murray and Jennings cite three areas that require rethinking of current assumptions regarding end-of- life care. These include greater attention to (1) the end-of-life care delivery system, (2) the approach to advance directives and surrogate decisionmaking, and (3) how we manage conflict and disagreement. ' Conflict is common during end-of-life decisionmaking. In a 2001 study, conflict was identified by at least one member of the clinical team in 78% of 102 cases of intensive care unit patients who were determined to have a likelihood of having treatment withheld or withdrawn.2 Conflict surrounding end-of-life care typically takes three forms: conflict among the patient's family members, between the family and the health care providers, and conflict that arises among the team members themselves. According to Breen and her co-authors, conflict among staff was identified in 48% of these cases, between staff and family members in 48% of the cases, and among family members in 24% of the cases.4 Conflict among family members who are tasked with decisionmaking on behalf of patients who are no longer able to decide for themselves is well documented and occasionally takes public focus, as in the unfortunate case of * Debra Gerardi, RN, MPH, J.D. is a mediator and health care conflict engagement specialist providing mediation/ facilitation services, systems design and conflict management training programs for healthcare organizations internationally. She is Chair of the Program on Healthcare Collaboration and Conflict Resolution at the Werner Institute for Negotiation and Dispute Resolution at Creighton University School of Law. 1 See Thomas H. Murray & Bruce Jennings, The Quest to Reform End of Life Care: Rethinking Assumptions and Setting New Directions, HASTINGS CENT. REP., Nov.-Dec. 2005, S52. 2 Catherine M. Breen et al., Conflict Associated with Decisions to Limit Life- sustaining Treatment in Intensive Care Units, 16 GEN. INTERNAL MED. 283 (2001). 3Id. at 285. 4 id.

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