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June 28, 2000

Handling Conflict in End-of-Life Care—Reply

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;283(24):3199-3200. doi:10.1001/jama.283.24.3198

In Reply: Dr Caplan describes a particular type of caregiver response, the identification of which will aid clinicians trying to resolve conflicts around end-of-life decision making. It could be classified as an example of extreme grief, guilt, or both.

Dr Lynn expresses understandable dismay at a "system" that does not encourage continuity with clinicians, end-of-life advance planning, and attention to families' needs. While we agree that such cases are unfortunate, our focus was on clinicians' responses to these situations when they do occur. The current environment of health care does not favor prevention or information-giving, whether for biomedical, social or emotional aspects of illness. Clinicians should work to decrease the frequency of conflicts and work to resolve disputes with understanding, empathy, and negotiation. Renewed attention must be placed on organizational aspects of caring.1

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