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Table 3. Recommended Steps for Resolution of Conflict Regarding Potentially Inappropriate Treatments 1. Before initiation of and throughout the formal conflict-resolution procedure, clinicians should enlist expert consultation to aid in achieving a negotiated agreement. 2. Surrogate(s) should be given clear notification in writing regarding the initiation of the formal conflict-resolution procedure and the steps and timeline to be expected in this process. 3. Clinicians should obtain a second medical opinion to verify the prognosis and the judgment that the requested treatment is inappropriate. 4. There should be case review by an interdisciplinary institutional committee. 5. If the committee agrees with the clinicians, then clinicians should offer the option to seek a willing provider at another institution and should facilitate this process. 6. If the committee agrees with the clinicians and no willing provider can be found, surrogate(s) should be informed of their right to seek case review by an independent appeals body. 7a. If the committee or appellate body agrees with the patient or surrogate's request for life-prolonging treatment, clinicians should provide these treatments or transfer the patient to a willing provider. 7b. If the committee agrees with the clinicians' judgment, no willing provider can be found, and the surrogate does not seek independent appeal or the appeal affirms the clinicians' position, clinicians may withhold or withdraw the contested treatments and should provide high-quality palliative care. Table 4. Questions to Assist in Illuminating Moral Issues in Time-pressured Situations • Am I certain that this requested treatment is outside of the boundaries of accepted practice? • Would I be willing to have the rationale for my decision publicly reviewed in an appeals board or court? • What are the consequences to the patient, surrogate, team, or institution as a result of implementing this decision? • Am I sure that sex, race, socioeconomic status, ability to pay, or other psychosocial factors are not entering into my decision? Management