The most critical element of effective early end-of-life decision making is:
a. control of distressing symptoms such as nausea, anxiety, and pain.
b. effective communication between the patient, family, and healthcare team throughout the course of the illness.
c. organizational support of palliative care principles.
d. relocation the dying patient from the critical care unit to a lower level of care.
B
The failure of clinicians, family members, and patients to openly discuss prognoses, end-of-life wishes, and preferences contributes to care conflicts such as in the Schiavo case. Early discussion of end-of-life wishes is required to promote positive outcomes for the patient and family, and actually should predate illness. Even though symptom control is a significant dimension of palliative care, it is not involved in initial end-of-life decision making. Adequate staffing and facility policies that support the dying patient are critical but should not impact family decision making. The patient should be cared for in an environment that best supports the needs of the patient and family. Even though organizational support of palliative principles is important, it should not drive individual decision making.
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