End-of-life decision making, an often sad and painful process, can be needlessly complicated by the perception that ethical dilemmas are an inevitable part of the process and necessarily result in a power struggle between patients, their families, and physicians. Ethical dilemmas do not arise in every end-of-life situation. More often, patients survive or die with little hint of an ethical problem. Typically, ethical dilemmas surface in that small number of cases in which there is genuine disagreement between the patient and the physician, between the family and the physician, among members of the family, or among members of the health care team who question the efficacy or appropriateness of continued aggressive treatment. In recent years, institutional ethics committees have increasingly become the forum for the resolution of these dilemmas. Therefore, the process of end-of-life decision making and the committee's role as consultant and mediator in the deliberation and resolution of these ethical dilemmas need to be better understood.

The role of ethics committees

In the context of clinical ethics, very few cases present true dilemmas. More often than not, the problem lies in poor communication between the parties, misinformation, denial of the seriousness of the illness, or reluctance to discuss the issues candidly. In some instances, ethical concerns need to be subordinated to prevailing law. For example, when a Jehovah's Witness refuses to accept blood transfusions or blood products, the law is clear that the patient's wishes must be respected.