New guidelines aim to resolve conflicts in treating critically ill patients

We congratulate our very own faculty member and co-author of the guidelines, Dr. Brenda G. Fahy, for her contribution to this important work.

New American Thoracic Society (ATS) guidelines discuss who decides what life-prolonging medical treatment patients in intensive care should receive and how both clinicians and a patient’s family should be involved. According to the authors of the policy, the guidelines solve what used to be a problematic question among intensive care patients, patient families, and clinicians.

The troubling question of who should decide what life-prolonging medical treatments a patient in the ICU should receive was taken up by the ATS. The ATS provides guidance for crucial decision-making in the care of patients with advanced critical illness while preventing conflicts between medical staff and family caregivers. Co-chair of the committee that produced the guidelines, Dr. Douglas White, believes that “neither individual clinicians nor families should be given unchecked authority to determine what treatments will be given to a patient.” Clinicians should not accept treatment requests that they feel are not in a patient’s best interest, nor should they refuse to provide treatment. If problems surface between clinicians and a patient’s family, a fair process of dispute resolution should begin where neither party can unilaterally impose their will on the other. The policy statement recommends the early involvement of expert consultation if conflicts cannot be resolved with ongoing dialogue.

The policy also outlines innovative procedures for situations that had become troublesome. For example, when families request treatment that is truly ineffective, the clinician should refuse to administer the treatment and thoroughly explain the rationale behind the treatment decision. In addition, for situations where medical urgency does not allow compliance with the longer dispute resolution process, the committee has provided expedited steps that will ensure a fair process.

“These guidelines provide clinicians with the framework to manage treatment disputes with an emphasis on procedural fairness, frequent communication, expert consultation and timeliness,” said co-chair Gabriel T. Bosslet.