Recommendations
Recommendation 1
Î Institutions should implement strategies to prevent intractable treatment
conflicts, including proactive communication and early involvement of
expert consultation.
Recommendation 2
Î The term "potentially inappropriate" should be used, rather than "futile,"
to describe treatments that have at least some chance of accomplishing the
effect sought by the patient, but clinicians believe that competing ethical
considerations justify not providing them. Clinicians should communicate
and advocate for the treatment plan they believe is appropriate. Requests
for potentially inappropriate treatment that remain intractable despite
intensive communication and negotiation should be managed by a fair
process of dispute resolution.
• The committee recommends the following approach to manage such cases:
1. Enlist expert consultation to continue negotiation during the dispute
resolution process
2. Give notice of the process to surrogates
3. Obtain a second medical opinion
4. Obtain review by an interdisciplinary hospital committee
5. Offer surrogates the opportunity to transfer the patient to an alternate
institution
6. Inform surrogates of the opportunity to pursue extramural appeal
7. Implement the decision of the resolution process
• When time pressures (such as a rapidly deteriorating clinical condition) make it infeasible
to complete all steps of the conflict-resolution process and clinicians have a high degree
of certainty that the requested treatment is outside accepted practice, they should refuse
to provide the requested treatment and endeavor to achieve as much procedural oversight
as the clinical situation allows.
