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Review
. 2023 Apr;70(4):724-735.
doi: 10.1007/s12630-023-02417-2. Epub 2023 May 2.

Navigating disagreement and conflict in the context of a brain-based definition of death

Christy Simpson  1   2 , Katarina Lee-Ameduri  3   4 , Michael Hartwick  5   6 , Randi Zlotnik Shaul  7   8 , Aly Kanji  9 , Andrew Healey  10   11 , Nicholas B Murphy  12 , Thaddeus M Pope  13
Affiliations
Review

Navigating disagreement and conflict in the context of a brain-based definition of death

Christy Simpson et al. Can J Anaesth. 2023 Apr.

Abstract
in English, French

In this paper, we discuss situations in which disagreement or conflict arises in the critical care setting in relation to the determination of death by neurologic criteria, including the removal of ventilation and other somatic support. Given the significance of declaring a person dead for all involved, an overarching goal is to resolve disagreement or conflict in ways that are respectful and, if possible, relationship preserving. We describe four different categories of reasons for these disagreements or conflicts: 1) grief, unexpected events, and needing time to process these events; 2) misunderstanding; 3) loss of trust; and 4) religious, spiritual, or philosophical differences. Relevant aspects of the critical care setting are also identified and discussed. We propose several strategies for navigating these situations, appreciating that these may be tailored for a given care context and that multiple strategies may be helpfully used. We recommend that health institutions develop policies that outline the process and steps involved in addressing situations where there is ongoing or escalating conflict. These policies should include input from a broad range of stakeholders, including patients and families, as part of their development and review.

RéSUMé: Dans cet article, nous discutons des situations dans lesquelles un désaccord ou un conflit survient dans le contexte des soins intensifs en ce qui concerne une détermination de décès selon des critères neurologiques, y compris le retrait de la ventilation et d’autres assistances somatiques. Compte tenu de l’importance pour toutes les personnes impliquées de déclarer une personne décédée, un objectif primordial est de résoudre les désaccords ou les conflits de manière respectueuse et, si possible, de préserver les relations. Nous décrivons quatre catégories différentes de raisons causant ces désaccords ou conflits : 1) le chagrin, des événements inattendus et le besoin de temps pour accepter ces événements; 2) les malentendus; 3) la perte de confiance; et 4) les différences religieuses, spirituelles ou philosophiques. Les aspects pertinents du milieu des soins intensifs sont également identifiés et discutés. Nous proposons plusieurs stratégies pour gérer ces situations, en étant conscients que celles-ci peuvent être adaptées à un contexte de soins donné et que plusieurs stratégies peuvent être utiles à appliquer. Nous recommandons que les établissements de santé élaborent des politiques qui décrivent le processus et les étapes nécessaires pour faire face aux situations où il y a un conflit en cours ou qui s’intensifie. Dans le cadre de leur élaboration et de leur examen, ces politiques devraient inclure les commentaires d’un large éventail d’intervenants, y compris les patients et les familles.

Keywords: conflict; critical care; determination of death; disagreement; ethics.

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Conflict of interest statement

Michael Hartwick receives a salary as Regional Medical Lead Donation from Ontario Health, Trillium Gift of Life Network. Thaddeus M. Pope served on the Uniform Law Commission study committee and serves on the drafting committee for the United States Uniform Determination of Death Act. He regularly receives honorariums for speaking on this at universities, hospitals, and professional societies.

References

    1. Poncet MC, Toullic P, Papazian L, et al. Burnout syndrome in critical care nursing staff. Am J Prespir Crit Care Med. 2007;175:698–704. doi: 10.1164/rccm.200606-806oc. - DOI - PubMed
    1. Pereira SM, Teixeira CM, Carvalho AS, Hernández-Marrero P, InPalln. Compared to palliative care, working in intensive care more than doubles the chances of burnout: results from a nationwide comparative study. PLoS One 2016; 11: e0162340. 10.1371/journal.pone.0162340 - PMC - PubMed
    1. Heyland DK, Dodek P, Mehta S, et al. Admission of the very elderly to the intensive care unit: family members’ perspectives on clinical decision-making from a multicenter cohort study. Palliat Med. 2015;29:324–335. doi: 10.1177/0269216314566060. - DOI - PubMed
    1. Ivany E, Aitken L. Challenges and facilitators in providing effective end of life care in intensive care units. Nurs Stand. 2019;34:44–50. doi: 10.7748/ns.2019.e11248. - DOI - PubMed
    1. Hinkle LJ, Bosslet GT, Torke AM. Factors associated with family satisfaction with end-of-life care in the ICU: a systematic review. Chest. 2015;147:82–93. doi: 10.1378/chest.14-1098. - DOI - PubMed