End-of-Life Care and Hospital Legal Counsel
There has been little attention to the role of hospital counsel in the daily practices that affect terminally ill patients. This report was drafted with recommendations, which are based on opportunities for hospital counsel to improve end-of-life care between the clinical and policy arenas. The seven themes that emerged in reviewing practices in this area include:
- Legal considerations, and the procedural decision framework created through the law, strongly influence how clinicians think about end-of-life care.
- Concern and confusion about what is, and is not, legally permissible are common components of clinical decision making.
- Hospital clinicians are often unaware of the institutional policies and protocols that were created to assist them in end-of-life care decision making and delivery.
- Hospital clinicians have little formal education in the legal aspects of end-of-life care. Instead they often rely on a variety of informal educational outlets that often transmit inaccurate or incomplete information about the law in the acute care setting.
- Hospital legal counsel are engaged in a variety of responsibilities and activities within the hospital, but their involvement in the hospital’s clinical or educational activities related to end-of-life care is limited. These attorneys also differ in their level of comfort with, and interest in, being involved with such issues.
- Hospital legal counsel currently have little contact with hospital clinicians, despite clinicians’ concerns about the law. Various approaches within hospital settings are being used to address and resolve legal concerns related to end-of-life care and these rarely involve hospital counsel.
- Clinicians have high regard for hospital counsel and report that their legal advice and recommendations strongly influence their own decisions about patient care.
As a result of discussing these themes, the following recommendations were made:
- Create educational opportunities
- Promote enhanced communication and advance care planning
- Translate between the clinical and policy arenas.
(This report can be accessed at www.milbank.org.)
