Conflict before the courtroom: Challenging cognitive biases in critical decision-making

Harleen Kaur Johal, Christopher Danbury

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Conflict is an important consideration in the Intensive Care Unit (ICU). In this setting, conflict most commonly occurs over the best interests of the incapacitated adult patient; for instance, when families seek aggressive life-sustaining treatments, which are thought by the medical team to be potentially inappropriate. Indeed, indecision on futility of treatment and the initiation of end-of-life discussions are recognised to be amongst the greatest challenges of working in the ICU, leading to emotional and psychological “burnout” in ICU teams. When these disagreements occur, they may be within the clinical team or amongst those close to the patient, or between the clinical team and those close to the patient. It is therefore crucial to have a theoretical understanding of decision-making itself, as unpicking misalignments in the family’s and clinical team’s decision-making processes may offer strategies to resolve conflict. Here, we relate Kahneman and Tversky’s work on cognitive biases and behavioural economics to the ICU environment, arguing that these biases could partly explain disparities in the decision-making processes for the two conflicting parties. We suggest that through the establishment of common ground, challenging of cognitive biases and formulation of mutually agreeable solutions; mediation may offer a pragmatic and cost-effective solution to conflict resolution. The litigation process is intrinsically adversarial and strains the doctor-patient-relative relationship. Thus an alternative external party should be considered, however mediation is not frequently utilised and more research is needed into its effectiveness in resolving conflicts in the ICU.
Original languageEnglish
Number of pages5
JournalJournal of Medical Ethics
Early online date6 Jul 2020
Publication statusE-pub ahead of print - 6 Jul 2020


  • Ethics
  • Dissent and Disputes
  • Conflict
  • Psychological
  • Intensive Care Units
  • Refusal to Treat

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