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ETH-029: Process for Resolving Disputes About Treatment Decisions

 
Process for Resolving Disputes About Treatment Decisions: The Wisconsin Medical Society supports the following provisions in regard to disputes about treatment decisions:

  1. If an attending physician and his patient are in disagreement about the use of a particular test or treatment, the physician should take the initiative to resolve this matter through the use of patient education and discussions, involving any family, medical, social service or chaplainry personnel needed to resolve the issue.
  2. If the issue cannot be resolved, then an ethics committee consult should be called. The consult may be called by anyone on the treatment team or by the patient or family. The attending physician may attend the meeting to give information but will not be a voting member of the committee. All life sustaining treatments (ventilators, IV fluids, antibiotics etc.) would be continued throughout the process defined below.
  3. The patient shall be informed of the committee review process not less than 48 hours before the meeting, unless the time period is waived by mutual agreement. The patient and anyone he chooses may attend the meeting and he/they will receive a written explanation of the decision reached during the review process.
  4. The written explanation will be included in the medical record.
  5. Often, the ethics committee will bring the parties together and resolve the issues that were in disagreement. If, however, the doctor or the patient does not agree with the ethics committee opinion, then the following will occur:
    1. The physician shall make a reasonable effort to transfer the patient to a physician who is willing to comply with the patient’s wishes. If the patient is in a health care facility, the facility personnel shall assist the physician in arranging the patient’s transfer to one of the following:
      1. another physician.
      2. an alternative care setting within that facility.
      3. another facility.
  6. If the patient is requesting life-sustaining treatment that the attending physician and the review process have decided is inappropriate, the patient shall be given available life-sustaining treatment pending transfer. The patient is responsible for any costs incurred in transferring to another facility.
    1. The physician and the health care facility are not obligated to provide life-sustaining treatment after the 10th calendar day after the written decision of the ethics committee is provided to the patient. (Exception to this: See #8.) All palliative and supportive care would continue to be provided to the patient and family.
  7. Life-sustaining treatment under this section may not be entered in the record as medically unnecessary until the time period has elapsed.

  8. At the request of the patient, the appropriate district or county court may extend the time period only if the court finds, by a preponderance of the evidence, that such an extension will help locate another physician or health care facility willing to accept the patient in transfer. (HOD, 0411)*

*Currently under five-year policy review.