- Journal
- ANESTHESIE & REANIMATION
- Année
- 2022
- Volume
- 8
- Numéro
- 1
- Pages
- 18-26
- Mois
- JAN
- DOI
- 10.1016/j.anrea.2021.10.008
Abstract
Most of withholding or withdrawing treatment decisions in intensive care unit are made in agreement with families. However, sometimes, family opposes to the plan of care. This situation leads to discussions and ethical questions, which allow over time to bring out a solution. But sometimes, this disagreement will be persistent and evolve into a real conflict. Several cases that have been publicised and brought to court in recent years have shown us how destructive these conflicts can be and how important it is to try everything to prevent legal proceedings. To avoid escalation, it is necessary to understand the reasons for these conflicts, their origin and what favours them. It is also necessary to get out of the questioning, ``who decides for the patient who is not able to express his will ?'' by opposing family and doctors, the question is not ``who'', but ``how''. Doctors and nurses must position themselves as caregivers. By listening to and accompanying families, they must aim to reach a common decision that best meets what the patient would have liked or, in paediatrics, what parents consider acceptable for their child and that they are able to endure. The establishment of this relationship of trust requires a strong involvement of caregivers in the relationship, knowledge of communication issues, as well as respect for a temporality specific to each case.