Q: What are the six-steps process to conflict resolution in clinical cases, where providers may believe that further care of the patient is futile?


Answer:

1. Inform the surrogate about the conflict resolution process, 
2. request review by a multidisciplinary hospital committee, 
3.  continue dialogue between the clinical team and surrogate, 
4.  inform surrogates of their right to seek legal intervention, 
5.  attempt to transfer the patient to a willing provider, and 
6.  implement a plan of care

Source: Ethics in the intensive care unit: Responding to requests for potentially inappropriate therapies in adults - Article from Douglas B White, MD, MAS in UpToDate

{Objective of above question is to highlight the fourth point - where there is often a failure to inform surrogates of their right to seek legal intervention, for obvious reasons!}


Further Readings:

1. Consensus statement of the Society of Critical Care Medicine's Ethics Committee regarding futile and other possibly inadvisable treatments. Crit Care Med 1997; 25:887.

2. Medical futility in end-of-life care: report of the Council on Ethical and Judicial Affairs. JAMA 1999; 281:937.