Asked by the University of Toronto Joint Centre for Bioethics, an international medical ethics think tank, to rank "the top 10 ethical challenges that Canadians may face in health care," 12 full-time ethicists at Toronto area hospitals cited as number one: disagreements over treatment decisions between health care professionals, patients and their families.
Panelists say such disagreements typically involve health care professionals who recommend a treatment option (i.e. increased or decreased treatment) with which patients and their families disagree, and vice versa.
In a paper published today in the peer-reviewed, open access UK journal BMC Medical Ethics, the researchers say that while such disagreements are most common in the intensive care unit, they occur in virtually every health care context, including palliative care, rehabilitation, mental health, surgery, internal medicine and family medicine.
Disagreements range from withdrawing aggressive treatment from a terminally ill patient to a family physician refusing a patient's request for antibiotics for a viral infection.
End-of-life critical care cases tend to be the most emotional and hardest to resolve, the recent public outcry surrounding patient Terri Schiavo in Florida a vivid example. (The survey was conducted prior to the Schiavo controversy, in which her immediate family members were very publicly conflicted over continuing life-support).
Such cases are usually very private, however, typically involving a family demanding that everything be done to maintain a patient's life versus a medical team that views continuing aggressive intervention as tantamount to torture. Families may cite deeply held religious beliefs an
Contact: Terry Collins
University of Toronto Joint Center for Bioethics