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likelihood of having treatment withheld or withdrawn.2 Conflict surrounding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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