End-of-life decision making in the intensive care unit

Physicians are increasingly involved in how their critically ill patients die [72]. The more this happens, the more physicians will have to understand not only how their own backgrounds and biases influence their medical management, but also the cultural and religious backgrounds of the patient and...

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Bibliographic Details
Published in:Intensive care medicine 2000-10, Vol.26 (10), p.1414-1420
Main Authors: NYMAN, D. J, SPRUNG, C. L
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthesiology
Attitude of Health Personnel
Attitude to Health
Bioethics
Biological and medical sciences
Cardiac arrest
Cardiopulmonary resuscitation
Chronic Disease
CPR
Critical care
Critical Care - methods
Critical Care - psychology
Critical Care - statistics & numerical data
Cultural Characteristics
Decision Making
Drug withdrawal
Emergency and intensive care: techniques, logistics
Europe
Family - psychology
Health Care Rationing
Humans
Intensive care
Intensive care medicine
Intensive care unit. Emergency transport systems. Emergency, hospital ward
Life Support Care - methods
Life Support Care - psychology
Life Support Care - statistics & numerical data
Medical Futility
Medical prognosis
Medical sciences
Patient Advocacy
Patient Selection
Patients
Physicians
Prognosis
Quality of Life
Resuscitation Orders
Terminal Care - methods
Terminal Care - psychology
Terminal Care - statistics & numerical data
United States
Ventilators
Citations: Items that cite this one
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Summary:Physicians are increasingly involved in how their critically ill patients die [72]. The more this happens, the more physicians will have to understand not only how their own backgrounds and biases influence their medical management, but also the cultural and religious backgrounds of the patient and surrogate [72, 73]. The medical profession must realise that, despite tremendous advances in medical knowledge and technology, not everyone can be saved all the time, even in the area of intensive care. Physicians must understand that "doing everything" that is best for the patient may not mean starting epinephrine or performing CPR, but rather may imply moving from a process of curing to caring with palliative care [10]. This process should be initiated by discussions with the patient or surrogate, and should include knowledge of the patients' wishes as demonstrated by advance directives and durable power of attorney. The patient's code status and the intention of forgoing life-sustaining treatment should be discussed with other members of staff together with the patient and/or family in a compassionate and humane manner. The wishes of the patient and family should be taken into consideration and the physician must try to make an impartial decision by doing what is medically and ethically correct and best for this specific patient. Hopefully, in this way, a more ethical and compassionate approach to end-of-life decisions in the ICU will be obtained.
ISSN:0342-4642
1432-1238
DOI:10.1007/s001340000641