Addressing uncertainty: what is the role of consensus in end-of-life care?

Excerpt

Uncertainty is a familiar companion in the practice of medicine, and this lack of certainty is abundant in end-of-life care. Medical decision-making at the end of life occurs in a complex milieu of personal values and beliefs, where tensions between patient autonomy, sanctity of life, quality of life, and social justice abound. Efforts to attenuate this uncertainty through rigorous scientific investigation may be met with legal and ethical challenges, and high-quality evidence is often absent. Without high-quality evidence to guide decision-making, the importance of consensus in end-of-life care becomes readily apparent. Although it may be impractical to establish a universal understanding of what is “beneficial” or what it means to “do no harm” at the end of life, achievement of consensus is possible in many different areas of end-of-life care [1]. When driven by a desire to improve the quality of dying and death for patients and their family members, consensus in end-of-life care can serve as an important source of direction for clinicians. In an article recently published in Intensive Care Medicine, Downar and colleagues [2] take on the challenging task of achieving consensus for the process of withdrawal of life-sustaining treatments. …