Medical Technology at the End of Life

Gillick, Muriel R.; Hesse, Katherine A.; Mazzapica, Nancy

doi:10.1001/archinte.1993.00410220038004

Cited by 97 publications

(7 citation statements)

References 8 publications

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“…The higher level of support when withdrawal of treatment is considered from the first as opposed to third person perspective confirmed one of our hypotheses and reflects previous research [19, 23]. In each case a large proportion were still uncertain about the morality of withdrawal of treatment, though this proportion halved when withdrawal of treatment was considered from the first person perspective in the case of VS.…”

Section: Discussionsupporting

confidence: 89%

Attitudes of Lay People to Withdrawal of Treatment in Brain Damaged Patients

2013

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BackgroundWhether patients in the vegetative state (VS), minimally conscious state (MCS) or the clinically related locked-in syndrome (LIS) should be kept alive is a matter of intense controversy. This study aimed to examine the moral attitudes of lay people to these questions, and the values and other factors that underlie these attitudes.MethodOne hundred ninety-nine US residents completed a survey using the online platform Mechanical Turk, comprising demographic questions, agreement with treatment withdrawal from each of the conditions, agreement with a series of ethical principles and three personality tests.ResultsMore supported treatment withdrawal from VS (40.2 % agreed, 17.6 % disagreed) than MCS (20.6 %, 41.2 %) or LIS (25.3 %, 35.8 %). Agreement with treatment withdrawal was negatively correlated with religiosity (r = −0.272, P < 0.001), though showed no significant relationship with need for cognition or empathy, and only a partial association with utilitarian judgment in a standard moral dilemma. Support for treatment withdrawal was most strongly associated with endorsement of the importance of patient autonomy, dignity, suffering, best interests. Distributive justice was not given significant weight by most. Importantly, agreement with treatment withdrawal was noticeably higher when considered from a first as opposed to third person perspective for VS (Z = −6.056, P < 0.001), MCS (Z = −6.746, P < 0.001) and LIS (Z = −6.681, P < 0.001).ConclusionLay attitudes to withdrawal of treatment in brain damaged patients are largely shaped by values similar to those central to the secular ethical debate. Neither traditional values such as the sanctity of life nor utilitarian values relating to resource allocation seem to play a central role. Far greater weight is given to autonomy, which may explain why participants were far more willing to endorse withdrawal of treatment when the issue was presented in the first person, or in relation to a concrete case involving a patient’s explicit wishes. Surveys focusing on abstract cases presented in the third person may not provide an accurate picture of lay attitudes to these critical ethical questions.

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Section: Discussionsupporting

confidence: 89%

Attitudes of Lay People to Withdrawal of Treatment in Brain Damaged Patients

2013

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“…Indeed, physicians and nurses who have extensive experience with serious illness are unlikely to wish aggressive end-of-life treatments for themselves. 17 However, there are problems with this explanation. If familiarity with serious illness were the factor that discouraged patients from seeking aggressive treatments, one would expect the preferences of patients who had experienced mechanical ventilation to be more resistant to the procedure than those who had not experienced mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

Do Physicians' Own Preferences for Life-Sustaining Treatment Influence Their Perceptions of Patients' Preferences? A Second Look

Schneiderman

Kaplan

Rosenberg

et al. 1997

Camb Q Healthc Ethics

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Previous studies have documented the fallibility of attempts by surrogates and physicians to act in a substituted judgment capacity and predict end-of-life treatment decisions on behalf of patients. 1 "" 9 We previously reported that physicians misperceive their patients' preferences and substitute their own preferences for those of their patients with respect to four treatments: cardiopulmonary resuscitation (CPR) in the event of cardiac arrest, ventilator for an indefinite period of time, medical nutrition and hydration for an indefinite period of time, and hospitalization in the event of pneumonia. 10 This paper extends our previous observations and reports on a different and larger population of subjects, employing a more detailed procedure-oriented advance directive instrument as well as a quality-of-life questionnaire. Our hypothesis remains the same, namely, that physicians' predictions of their patients' endof-life treatment choices are closer to the choices they would make for themselves than to the choices expressed by their patients. Since physicians are the ones who ultimately exercise control over these important decisions, any unrecognized projection of personal preferences onto their patients would raise serious concerns about physicians acting in a substituted judgment capacity. It would also emphasize the importance of patients choosing surrogate decisionmakers carefully and, even more important, explicating clearly their directive instructions as part of advance care planning. Methods Subjects and SettingThe study was carried out at the University of California, San Diego (UCSD) after review and approval by the institutional review board. It was part of a larger project involving 204 patients with acquired immune deficiency syndrome (AIDS) and cancer. The project was designed to investigate the effects of advance directives on medical treatments and costs. Physicians at the UCSD Cancer Center and at a clinic devoted to the treatment of patients with AIDS were asked to identify all patients who they estimated had less than a 50% chance of surviving 5 years.Recruitment for this component of the study occurred between May 1991 and May 1993. During this period, each of 111 surviving patients was asked to identify the physician who was primarily responsible for his or her care. A total of 50 physicians were identified by the 111 patients. The identified physicians were

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“…Die Ergebnisse von Gillick et al [8] und Schöne-Seifert [20], dass die Pflegekräfte in solchen Untersuchungen sämtliche Therapiemaßnahmen häufiger als die Ärzte ablehnen, können hier nicht bestätigt werden. Eine Erklärung für die in dieser Arbeit einheitlichere Tendenz zwischen den Berufsgruppen könnte die ausschließliche Befragung von Pflegekräften der Intensivstationen sein, während in den anderen Arbeiten Pflegekräfte aus dem ganzen Krankenhaus befragt wurden, die nicht alle intensivmedizinische Erfahrungen besitzen.…”

Section: Diskussionunclassified

Durch welche Faktoren werden Therapiebegrenzungen auf internistischen Intensivstationen beeinflusst?

Dlubis-Dach¹,

Glogner²

2001

Ethik in der Medizin

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Which factors influence the limitation of therapy in internal intensive care units?Abstract. Definition of the problem: Every decision for or against life-sustaining measures in ICUs is a result of different factors, the kind and course of the illness, probable prognosis, age of the patient, but also character, experience and knowledge of the acting staff members. These factors may combine in an accidental way. The aim of the investigation was to evaluate these factors as far as possible. Arguments and conclusion: 287 physicians from intensive care units (ICU) in 43 hospitals were interviewed. In a questionnaire, 6 case vignettes of severely ill patients served for hypothetical reasons and eventually decisions to act. Maximum medical activity was recommended in university hospitals, but acute lifesustaining measurements were equally accepted in all three kinds of hospitals. Other factors -such as duration of medical activity of the doctors, years of experience in intensive care medicine, motivations to act, sex and life attitude, but also the age of the patients -were of no significance. Because of the traditional close cooperation in ICUs, the nursing staff was also interviewed. For reanimation, intubation/artificial ventilation and pain relief therapy there where no differences in the group of doctors. These were significant in invasive diagnostic and therapeutic measurements, which were generally rejected earlier and more easily by the nursing staff. Zusammenfassung. 287 Ärzte/Ärztinnen aus internistischen Intensivstationen von 43 Krankenhäusern verschiedener Versorgungsgrade wurden mit Hilfe einesFragebogens an Hand von 6 Fallbeschreibungen befragt, welche Maßnahmen sie bei einer bestimmten Krankheitskonstellation noch durchführen würden. Gleichzeitig wurde der Einfluss bestimmter persönlicher Faktoren auf die Entscheidungen überprüft. Im Ergebnis führt die Tätigkeit in einer Universitätskli-nik zu einer stärkeren Befürwortung des therapeutischen Maximums. Die übri-gen Faktoren (Dauer der Berufstätigkeit, Intensiverfahrung, Entschlossenheit zu

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Medical Technology at the End of Life

Cited by 97 publications

References 8 publications

Attitudes of Lay People to Withdrawal of Treatment in Brain Damaged Patients

Attitudes of Lay People to Withdrawal of Treatment in Brain Damaged Patients

Do Physicians' Own Preferences for Life-Sustaining Treatment Influence Their Perceptions of Patients' Preferences? A Second Look

Durch welche Faktoren werden Therapiebegrenzungen auf internistischen Intensivstationen beeinflusst?

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