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"There are frequent calls for improving end-of-life care in the United States. In a recent Hastings Center special report, Murray and Jennings cite three areas that require rethinking of current assumptions regarding end-of-life care. These include greater attention to (1) the end-of-life care delivery system, (2) the approach to advance directives and surrogate decisionmaking, and (3) how we manage conflict and disagreement.
Conflict is common during end-of-life decisionmaking. In a 2001 study, conflict was identified by at least one member of the clinical team in 78% of 102 cases of intensive care unit patients who were determined to have a likelihood of having treatment withheld or withdrawn. Conflict surrounding end-of-life care typically takes three forms: conflict among the patient's family members, between the family and the health care providers, and conflict that arises among the team members themselves."