Managing Conflict at the End-of-Life

Abstract

There are increasing pressures to admit patients to intensive care units (ICUs). The majority of people now die in institutions, rather than at home. Even terminally ill patients in nursing homes sometimes find their way into acute hospitals. Once in the emergency department, they are often assessed and admitted to hospital as the history and prognosis may not initially be clear; and because it is usually easier, in purely practical terms, to admit a terminally ill elderly patient rather than to arrange appropriate support in the community. Once in an acute hospital there are expectations, realistic or not, that there is some hope. The conveyor belt to intensive care is further facilitated by increasingly specialized physicians who often do not understand the way different co-morbidities and multiorgan involvement influences the patient’s prognosis.