The role of policy and law in shaping the ethics and quality of end-of-life care in intensive care

Excerpt

The interplay between health policies and culture at the institutional, regional, and national level are important yet understudied questions in medicine. How do policies influence culture and vice versa? Does culture have more influence on policy, or does it more often flow the other direction? These are important empirical questions which have wide-ranging implications for both policy makers and those who want to improve clinical care. Institutional culture, or the collective values, beliefs, and behavioral norms of an institution, influence clinical practice patterns, behaviors, and attitudes [1]. Policies influence clinical practice patterns through direct influences of policy, but also indirectly through culture (Fig. 1). It is thus essential to understand how the intended and unintended consequences of policy changes might positively or negatively impact clinician attitudes and behaviors, as well as patient and family outcomes. If employed strategically and thoughtfully, institutional, regional, and national policy change can be a useful intervention to improve end-of-life care and foster institutional cultures that promote high-quality palliative care.

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