ABCD Exchange : March 1999 : Resources - Hospital Legal Counsel

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End-of-Life Care and the Role of Hospital Legal Counsel

Many Americans spend their last days in hospitals. There, difficult questions regarding termination of treatment, proxy decision making, and the legal ramifications of such choices are often part of the puzzle. Yet there is considerable uncertainty about the role of hospital legal counsel in these situations. To better define that role, the Milbank Memorial Fund and the United Hospital Fund teamed up to study the role of legal counsel in six hospitals in New York City. The results are published in End-of-Life Care and Hospital Legal Counsel: Current Involvement and Opportunities for the Future, by Connie Zuckerman.

Zuckerman reports that at some point in time, medical care became inextricably intertwined with legal issues - from medical malpractice concerns to guardianship and proxy designations. As a result, health care providers strive to deliver quality care that is consistent with patient choices while remaining within the boundaries of the law. This tug-of-war has resulted in fairly widespread anxiety about the law among clinicians, most notably when patients face the end of life. Though many of the clinicians interviewed for the study expressed such anxiety, most had not considered using their hospital legal counsel as a resource. Similarly, hospital legal counsel had not actively sought to dispel any confusion or excessive concerns about the legal ramifications of clinical choices. This disconnect between the two professions is the study’s overriding finding.

Other common themes among the various institutions included:

  1. Hospital clinicians are often unaware of the institutional protocols created to help them with difficult issues surrounding end-of-life care decision making.

  2. Though hospital legal counsel are engaged in a variety of activities within the hospital, rarely are they involved in the hospital’s clinical or educational activities related to end-of-life care.

  3. Clinicians have high regard for hospital legal counsel and report that their recommendations strongly influence the care ultimately given to the patient.
The editors conclude the report with some recommended "action steps" in an effort to build a bridge from the legal concerns to the clinical ones and note that there is a huge potential for positive change by increasing utilization of hospital legal counsel in educational and clinical arenas.

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This content is provided by Americans for Better Care of the Dying. For more information, visit www.abcd-caring.org.