Decision-Making on Withholding or Withdrawing Life Support in the ICU

Lobo, Suzana M.; Simoni, Flávio F.H.B. De; Jakob, Stephan M.; Estella, Ángel; Vadi, Sonali; Bluethgen, Andreas; Martín‐Loeches, Ignacio; Sakr, Yasser; Vincent, Jean‐Louis

doi:10.1016/j.chest.2017.04.176

Cited by 101 publications

(79 citation statements)

References 20 publications

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“…In a Brazilian study, 46% of medical students did not object to withdrawing artificial life support (23), while 75% of the medical students were willing to withdraw mechanical ventilation in our study. The variability among countries regarding the withdrawal of mechanical ventilation probably explains this difference (24). However, the students seem to comply with the practices of experienced physicians in Finland as 81% of the GPs also withdrew mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

Does Decision-making in End-of-life Care Differ Between Graduating Medical Students and Experienced Physicians?

Alminoja¹,

Piili²,

Hinkka³

et al. 2019

In Vivo

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Background/Aim: Appropriate decision-making in end-of-life (EOL) care is essential for both junior and senior physicians. The aim of this study was to compare the decisionmaking and attitudes of medical students with those of experienced general practitioners (GP) regarding EOL-care. Materials and Methods: A questionnaire presenting three cancer patient scenarios concerning decisions and ethical aspects of EOL-care was offered to 500 Finnish GPs and 639 graduating medical students in 2015-2016. Results: Responses were received from 222 (47%) GPs and 402 (63%) students. The GPs withdrew antibiotics (p<0.001) and nasogastric tubes (p=0.007) and withheld resuscitation (p<0.001), blood transfusions (p=0.002) and pleural drainage (p<0.001) more often than did the students. The students considered euthanasia and assisted suicide less reprehensible (p<0.001 in both) than did the GPs. Conclusion: Medical students were more unwilling to withhold and withdraw therapies in EOLcare than were the GPs, but the students considered euthanasia less reprehensible. Medical education should include aspects of decision-making in EOL-care. There is a growing demand for palliative care in Europe due to the increase in noncommunicable diseases (1). Therefore, physicians should have basic skills needed to change the goal of the treatment from life-prolonging therapies to end-of-life (EOL)-care. Appropriate decisions needed for high-quality EOL-care involve, for example, statements regarding cardiopulmonary resuscitation (CPR), hydration, and diagnostic tests. Many physician-related factors (e.g., age, experience and personal attitudes) have been shown to influence these decisions (2-4). In addition, the changing public attitudes towards EOL-care and euthanasia influence the complexity of these issues (5). The physicians' decisions regarding life-sustaining treatments vary between different treatment modalities (6-8). In a survey of American internists, blood products and haemodialysis were among the most likely withdrawn therapies, while mechanical ventilation and intravenous fluids were more commonly continued (6). Withdrawing treatment is generally experienced as more difficult than withholding them (9). The education and experience of a physician have been shown to influence decision-making in EOL-care (8, 10). Although newly-graduated physicians often feel unprepared for providing EOL-care, they face the complexity of the decision-making process just as the senior physicians (11, 12). However, the difference between graduating medical students and physicians in making these decisions remains to be studied.

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Section: Discussionmentioning

confidence: 99%

Does Decision-making in End-of-life Care Differ Between Graduating Medical Students and Experienced Physicians?

Alminoja¹,

Piili²,

Hinkka³

et al. 2019

In Vivo

View full text Add to dashboard Cite

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“…4,10 The factors associated with limitation of LST are numerous and include increasing age, severe comorbidities, admission following emergency surgery or trauma, and CPR within the 24 hours prior to admission to ICU. 4,10,11 Results from a multicenter study demonstrate that religious affiliation and geographical location influence clinicians' stance toward limitation of LST, with health care professionals from Southern Europe being more in favor of continuing treatment and prolonging life than their Northern European counterparts. 4,12 The ETHICUS group reported in a landmark study the importance of religious affiliations and culture on EoL decisions in European ICUs.…”

Section: Withhold/withdraw Life-sustaining Treatmentmentioning

confidence: 99%

End-of-Life Issues in Intensive Care Units

Metaxa

2020

Semin Respir Crit Care Med

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Critical care clinicians strive to reverse the disease process and are frequently faced with difficult end-of-life (EoL) situations, which include transitions from curative to palliative care, avoidance of disproportionate care, withholding or withdrawing therapy, responding to advance treatment directives, as well as requests for assistance in dying. This article presents a summary of the most common issues encountered by intensivists caring for patients around the end of their life. Topics explored are the practices around limitations of life-sustaining treatment, with specific mention to the thorny subject of assisted dying and euthanasia, as well as the difficulties encountered regarding the adoption of advance care directives in clinical practice and the importance of integrating palliative care in the everyday practice of critical-care physicians. The aim of this article is to enhance understanding around the complexity of EoL decisions, highlight the intricate cultural, religious, and social dimensions around death and dying, and identify areas of potential improvement for individual practice.

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“…End of life (EOL) management is a daily practice in intensive care units (ICU). In a recent worldwide audit of ICUs 13% of 9 524 included patients had a decision to withhold or withdraw life-sustaining treatment (1). Among 50% of death occurring in ICU, are secondary to a decision of withholding or withdrawal (WW) life support because of futility (2).…”

Section: Introductionmentioning

confidence: 99%

End of life practice and perceptions among physicians and residents in Intensive Care Units managed by anesthesiologists: a French national survey

Garcia¹,

Ichaï²,

Quintard³

2020

Preprint

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Background In France, death after decision to withdrawal or withholding sustaining life therapies concerns about 10% of intensive care unit (ICU) patients. Clayes-Leonetti law published in 2016 intend to frame our medical exercise. The purpose of this study is to review the current practice concerning end of life (EOL) management in French ICU.Methods Two national surveys were conduct, the first one consisted in 30 multiple choices questions about epidemiology, EOL decisions making, care organization and self-opinion sent by mail to senior

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Decision-Making on Withholding or Withdrawing Life Support in the ICU

Cited by 101 publications

References 20 publications

Does Decision-making in End-of-life Care Differ Between Graduating Medical Students and Experienced Physicians?

Does Decision-making in End-of-life Care Differ Between Graduating Medical Students and Experienced Physicians?

End-of-Life Issues in Intensive Care Units

End of life practice and perceptions among physicians and residents in Intensive Care Units managed by anesthesiologists: a French national survey

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