About four years ago, Beth Israel Deaconess established a policy for handling cases when doctors and patients - or patients' families - disagree about stopping treatment. The policy sets up a methodical appeal, hearing and review process when a doctor concludes further treatment would be ineffective or harmful, and a patient or family feels otherwise. The process includes review by a committee with a social worker, clergy member, and doctors not involved with the case.
If the committee decides further treatment is ineffective and/or harmful, the patient or family is offered the opportunity to seek transfer to a facility willing to provide that treatment. They also are advised that they can seek legal intervention.
Given how emotionally charged - and intertwined with family dynamics - the decision often is, "sometimes we have to help the patient figure out what the patient really wants," said Dr. Lachlan Forrow, director of Beth Israel's palliative care and ethics programs. Forrow helped write the policy.
Lazar points out that many patients do not make their end-of-life wishes known to their family.
A 2005 Massachusetts End of Life Care Survey found that 83 percent of those questioned said they didn't want to be a burden on loved ones at the end of their lives. But only about half, 53 percent, said they have spoken with their spouse or partner about their wishes for end of life care, and 57 percent indicated they had spoken with family. A mere 10 percent had discussed the issue with their primary care physician.
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