A new policy statement from the American Thoracic Society provides guidance for crucial decision-making for intensive care patients while preventing conflicts between medical staff and family caregivers. The guideline appears in the American Journal of Respiratory and Critical Care Medicine.
The authors state that both the clinician and the patient’s family should be involved in which treatments the critically ill patient should receive. The guidelines highlight the prevention of conflicts in the intensive care unit between the patient’s family and the clinicians. If conflicts cannot be resolved with ongoing dialogue, early involvement of expert consultants (eg, palliative care and ethics consultants) is recommended to reach a negotiated agreement. If a dispute remains unresolved after intensive communication and negotiation, a fair process involving a case review by a multidisciplinary ethics committee within the hospital, ongoing medication, a second medical opinion, an option to transfer the patient to an alternate institution, and information about the family’s right to appeal to the courts is recommended.
In addition, the policy statement recommends that when families request treatment that is truly futile, clinicians should refuse and explain the rationale. In situations where the medical urgency does not allow compliance with the longer dispute process, the guidelines provide fair but expedited steps.
The guidelines are supported by the Society of Critical Care Medicine, the American Association of Critical Care Nurses, the American College of Chest Physicians and the European Society of Intensive Care.
For more information visit thoracic.org.