The Value in Doing Something

Objectives: Evaluate the reasons why attempts at redirection, especially at the end of life, often fail, and patients and families insist on treating the underlying illness. Setting: Conflicts between patients and caregivers regarding the appropriate course of treatment. Main Results: Clinicians typically understand requests for treatment merely as means to obtain effective care. However, patients and families often request treatment as a way to exert their agency, avoid a sense of responsibility for unwanted outcomes, and express compassion. Conclusions: In response to devastating illness, patients and families are frequently motivated by factors that go beyond obtaining effective care. Awareness of these factors can help clinicians to identify sources of potential conflict and continue to provide compassionate care. The opinions expressed are the author’s own. They do not represent the position or policy of the National Institutes of Health, the U.S. Public Health Service, or the U.S. Department of Health and Human Services. Supported, in part, by the Intramural Research Program at the National Institutes of Health Clinical Center. Dr. Wendler received support for article research from the National Institutes of Health. For information regarding this article, E-mail: dwendler@nih.gov Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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