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Conflicts within the healthcare team
Discrepancies between nurse and physician perception of the degree of inclusion in decision-making have been reported. In a French study 51%(?) of physicians felt that end-of-life decisions were collaborative, but only 27% of nurses agreed. In Japan, nurses reported lack of congruence with physicians on sedation for intractable distress to be a significant cause of emotional burden (Morita Sep 2004). Barreth et al (2003) acknowledge that communicating the intent to relieve symptoms rather than to hasten death may be difficult. Lanuke et al [2003] emphasise the need to include all involved staff in the decision-making process. This permits staff members who may have ethical or other concerns to express them prior to involving them in care that they consider questionable, and so improves the chances of a smoother treatment course.
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