Craig M Nelson1, Blanca Arriola Nazareth. 1. Director of Medical Bioethics at the South Bay Medical Center in Harbor City, CA. E-mail: craig.m.nelson@kp.org.
Abstract
INTRODUCTION: We established a fair and explicit nonbeneficial treatment and conflict resolution policy at our medical center. The policy was designed to help us acknowledge and respect both patients and clinicians involved in treatment planning and decision making. OBJECTIVE: To qualitatively describe how our hospitalwide nonbeneficial treatment and conflict resolution policy was used. DESIGN: Retrospective evaluation of all bioethics consultations from November 6, 2009, when the policy was adopted, through August 6, 2012. Case-specific data were obtained when nonconsensus occurred involving withholding or withdrawing of nonbeneficial treatment. MAIN OUTCOME MEASURES: Rates of resolution of conflicts and treatment plan consensus when nonbeneficial treatment was withheld or withdrawn. RESULTS: We identified 146 (39.4%) cases where there was a treatment-level conflict between patients/surrogates and the treatment teams responsible for their care. In 54 (37.0%) of the cases, resolution occurred. In 92 (63.0%) of the cases, nonbeneficial treatment was eventually withheld or withdrawn. In 87 (94.6%) of the cases where treatment was withheld or withdrawn, the treatment teams and patients/surrogates reached consensus by the conclusion of the bioethics consultation process using the fair and explicit nonbeneficial treatment and conflict resolution policy. CONCLUSION: A fair and explicit nonbeneficial treatment and conflict resolution policy can result in a high level of consensus between patients/surrogates and the treatment teams responsible for their care when treatment is withheld or withdrawn.
INTRODUCTION: We established a fair and explicit nonbeneficial treatment and conflict resolution policy at our medical center. The policy was designed to help us acknowledge and respect both patients and clinicians involved in treatment planning and decision making. OBJECTIVE: To qualitatively describe how our hospitalwide nonbeneficial treatment and conflict resolution policy was used. DESIGN: Retrospective evaluation of all bioethics consultations from November 6, 2009, when the policy was adopted, through August 6, 2012. Case-specific data were obtained when nonconsensus occurred involving withholding or withdrawing of nonbeneficial treatment. MAIN OUTCOME MEASURES: Rates of resolution of conflicts and treatment plan consensus when nonbeneficial treatment was withheld or withdrawn. RESULTS: We identified 146 (39.4%) cases where there was a treatment-level conflict between patients/surrogates and the treatment teams responsible for their care. In 54 (37.0%) of the cases, resolution occurred. In 92 (63.0%) of the cases, nonbeneficial treatment was eventually withheld or withdrawn. In 87 (94.6%) of the cases where treatment was withheld or withdrawn, the treatment teams and patients/surrogates reached consensus by the conclusion of the bioethics consultation process using the fair and explicit nonbeneficial treatment and conflict resolution policy. CONCLUSION: A fair and explicit nonbeneficial treatment and conflict resolution policy can result in a high level of consensus between patients/surrogates and the treatment teams responsible for their care when treatment is withheld or withdrawn.