‘End-of-life’ decision making within intensive care - objective, consistent, defensible?

Aj, Ravenscroft; Bell,

doi:10.1136/jme.26.6.435

Cited by 30 publications

(13 citation statements)

References 24 publications

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“…25 A study of United Kingdom nurses found that nurses had little knowledge of the distinctions between different forms of endof-life decisions. 26 Many Israeli nurses and nursing students also supported PAD. [27][28][29] For example, 73% of oncology and 80% of non-oncology Israeli nurses supported PAD for patients who are in pain.…”

Section: Non-american Nurses' Attitudes Toward Hastening the Dying Prmentioning

confidence: 99%

Israeli critical care nurses’ attitudes toward physician-assisted dying

Ganz

Musgrave

2006

Heart & Lung

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Section: Non-american Nurses' Attitudes Toward Hastening the Dying Prmentioning

confidence: 99%

Israeli critical care nurses’ attitudes toward physician-assisted dying

Ganz

Musgrave

2006

Heart & Lung

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“…Arguably, neither is it ethical for intensivists to succumb to such pressures, for to do so fails their fiduciary duty to the patients they admit who will not benefit and may even be harmed by enduring the pain of procedures serving only to prolong their dying; to those who could benefit but are not given priority for socioeconomic reasons; and to those who see their treatments arbitrarily limited based on beliefs regarding their likelihood of survival when another 'more appropriate' patient presents. Nevertheless, such practices are understandable in view of the lack of support for such decision making and the lack of consensus on what constitutes appropriate care [16,17]. …”

Section: Triage Decision Making: Ethical and Legal Quandariesmentioning

confidence: 99%

“…Although each intensivist is held accountable for the decisions he or she makes, the means to appeal against these decisions in a fair and timely manner in such an acute setting remain problematic. If accountability for reasonableness is the best model for admission/discharge and triage policies, then much work must be done to develop a consensus regarding relevant nonmedical criteria, to educate public and professionals alike [17], and to establish a formal appeals mechanism that takes into account the unique nature of ICU practice. Certainly, a plan for broader public education at this point can only help to improve any decision-making process, both on an individual patient level by better informing advance care planning, and on a societal level by developing consensus on how these scarce resources can best be allocated.…”

Section: Ethical Models Of Resource Allocationmentioning

confidence: 99%

Untitled

Hawryluck

2006

Crit Care

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During the past few years the ethics sections of critical care societies have proposed a number of policies describing the goals of intensive care unit (ICU) care and providing broad guidance on the diagnoses and physiological criteria that would mandate using the specialized skill and technologies of an ICU environment. Discussions on what constitutes appropriate use of such scarce resources, incorporating cultural and religious beliefs and exploring how they interact with these medical criteria, remain vague. To date, these policies do not provide any definitive guidance in the difficult decision making faced by clinicians. Some argue that they were never meant to do so and yet they have served to guide the development of local hospital policies. Many have explored how critical care services are allocated without achieving consensus on the best way to achieve fair and equitable access to life-sustaining interventions. A consensus is needed though, one that is reflective of both individual and societal values and goals. Otherwise, increasing pressure to provide treatments with marginal benefits at best will threaten the ability of others to access treatments that may offer them very real benefits.

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“…Long‐term tube feeding is an integral part of the management of many patients with chronic illness. In the majority of cases the decision to tube feed is made with relative ease, however, in a growing number of cases the decision is becoming an ethical, legal, professional and personal dilemma for all involved (Ravenscroft & Bell, 2000).…”

Section: Introductionmentioning

confidence: 99%

Tube feeding controversial patients: what do dietitians think?

Healy¹,

McNamara

2002

J Human Nutrition Diet

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The use of tube feeding in some patients can be controversial, however, few studies have investigated dietitians' opinions on this subject. A cross-sectional survey of 345 members the Irish Nutrition and Dietetic Institute was conducted using a self-administered, anonymous, postal questionnaire. A 44% response rate was achieved. Mean number of years qualified was 9.3 (8.4). Eighty-one per cent of responders were involved in initiating tube feeding in stroke patients, and 8.5% in discontinuing tube feeding in a patient in a persistent vegetative state (PVS). Nine per cent felt that their input had no influence on the care plan of the patient with dementia and 67% felt that the information given to families (or other decision makers) concerning tube feeding was inadequate. The majority of respondents favoured tube feeding fictitious stroke and cancer patients, but less than half favoured tube feeding a fictitious patient in a PVS or a patient with dementia. When given similar scenarios involving themselves, fewer dietitians wanted to be tube fed.

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‘End-of-life’ decision making within intensive care - objective, consistent, defensible?

Cited by 30 publications

References 24 publications

Israeli critical care nurses’ attitudes toward physician-assisted dying

Israeli critical care nurses’ attitudes toward physician-assisted dying

Untitled

Tube feeding controversial patients: what do dietitians think?

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