Tolerance & integrity: defining boundaries of acceptable treatment & non-treatment decisions

Clinical ethics consultations often involve some degree of conflict between patients (or their parents) and clinical teams regarding pursuing--or not pursuing--a specific treatment, or regarding some other request or behavior. Examples include refusal of immunizations or potential life-sustaining therapy; requests for care outside the standard of practice, or to withhold diagnostic or prognostic information, or to provide invasive interventions; or the challenges of providing medical care in the context of extreme non-adherence or verbal abuse. This talk outlines key concepts of what we will call principled conflict management. Principled conflict management requires the exercise of tolerance--which is to say, the virtue of having the judgment to discern which refusals or requests to accommodate and which to resist (and to what degrees), and having the ability to abide by this judgment. Practical guidance will be provided.