title: [Decision conflicts with relatives in the intensive care unit].
abstract: BACKGROUND
  If medicine is coming close to its limits conflicts sometimes occur. Most conflicts in the intensive care unit (ICU) involve the medical team and patients' relatives. In particular decisions about withholding and withdrawing life-sustaining therapy lead to conflicts. Decisions about limiting life-sustaining treatment are burdened by conflicts and put an enormous strain particularly on relatives.
  
  
  OBJECTIVE
  Illustration of currently available studies and existing recommendations on how to manage potentially conflict-laden decision-finding discussions on the ICU are presented.
  
  
  METHODS
  This article is based on a selective literature research in the PubMed database.
  
  
  RESULTS
  Studies have been carried out to evaluate posttraumatic stress disorders in relatives who were involved in life-limiting treatment decisions. Conflicts on the ICU put an emotional strain on relatives. Evidence-based recommendations are available regarding physicians' attitudes during discussions about therapy decisions, communication style and other contextual factors. Study results show that the emotional stress level relatives have to endure can be reduced if conversations between patients' families and the clinical personnel were conducted according to these recommendations. The involvement of a clinical ethics committee can prevent conflicts and has been shown to have no impact on the mortality rate but does decrease the time life-sustaining measures were unsuccessfully pursued.
  
  
  CONCLUSIONS
  To prevent conflicts between the medical personnel and patients' relatives on the ICU, a timely, congruent and empathic conversation style in an appropriate, quiet environment is essential. Consultation with clinical ethics committees is recommended to de-escalate disputes.
authors.affiliation: Neurochirurgische Klinik Heidelberg, Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Ratliff
authors.affiliation: Neurochirurgische Klinik Heidelberg, Universität Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland. jan-oliver.neumann@med.uni-heidelberg.de.
authors.forename: J-O
authors.initials: JO
authors.lastname: Neumann
mesh_terms: D003142:Communication; D003657:Decision Making; D006801:Humans; D007362:Intensive Care Units; D010348:Patient Care Team
keywords: Communication; Ethics committees, clinical; Religion; Stress disorders, posttraumatic; Treatment limitation decision