Eli's Hospice Insider

Published on Wed Jun 02, 2010 PDF

The issues that seem to cause the conflict are rarely the real issues.

End-of-life decisions aren't always easy to make. When care-givers and family come together to discuss these issues, conflict can easily erupt. Larry Bridgesmith, JD, with the Institute of Conflict Management at Lipscomb University in Nashville, Tenn offers these five suggestions for easing conflict in end-of-life discussions:

1. Begin early. One problem that causes conflict in end-of-life care is that the important discussions get put off, Bridgesmith says. When a family is in crisis mode, it's much more difficult to make tough decisions without conflict.

There is a benefit of forethought used in making these choices such as with advanced directives, Bridgesmith says. These expressions of a loved one's desires give the family something to look back at. Conversations and expressions of preferences offer a guide to which adjustments can be made as needed.

2. In times of crisis we are least rational. Studies have shown that under pressure, as little as two percent of our thinking is truly rational, Bridgesmith says. With end-of-life discussions, there is a lot of emotion that gets in the way of reason. Ensure that end-of-life discussions are conducted in a non-threatening fashion. You may need to involve a third party such as a counselor or clergy. The more emotionally safe the participants feel, the better the conversation will be.

3. The issues that seem to cause the conflict are rarely the real issues. Most end-of-life conversation tends to focus on the nature of the care, the time frame, and the costs, Bridgesmith says. The deeper issues that really matter -- like fear, security, and dignity -- tend to remain hidden below the surface. These interests can be more important to the conversation than the issues being discussed.

4. Utilize processes. "The longer we stay fixed on conflict areas, the less we tend to agree," Bridgesmith says. In times when conversation participants seem stuck, consider the process points of the discussion. Is it the wrong time to be having this conversation? Taking a break might help ease things. Would a different location, perhaps away from the patient, make the conversation easier? Perhaps the conversation should be reconvened with a neutral third party to help work out an agreement. When participants are stuck in their positions, letting the conversation subside for a while can actually make things more productive when you resume.

5. Trust outside advisors. Bio ethicists, clergy, trained facilitators, and social workers can all help people working trough end of life conflict, Bridgesmith says.