Their perceptions of the goal of treatment may differ as well. These differences, which are exacerbated by poor communication, are the most common cause of conflict. To help avoid or resolve conflict, physicians must start by attending to patients and surrogates values, goals, and concerns. Physicians then must communicate in advance with patients or their surrogates about the likelihood of their withholding or withdrawing futile treatments. Doing so makes care providers accountable for their decisions, builds trust, and averts concerns regarding rationing of care and abandonment.
Patients also bear some responsibility for avoiding or resolving conflict.
For their part, they must be willing to communicate openly with their physician and plan advance directives. In most cases, patients and families are relieved when the physician initiates the discussion about these potential sources of conflict. For example, all parties concerned may agree in advance that when the patient becomes comatose and ventilator-dependent and has only days left to live, care will be continued long enough to give loved ones from out of state the opportunity to be with and support the patient when care is stopped. Of course, this process is made easier in hospitals where policies for futile and limited futile treatment are already in place. Unfortunately, many hospitals underutilize their own policies and the content of some policies is too vague or ambiguous to be of any practical benefit.