Personalizing Death in the Intensive Care Unit: The 3 Wishes Project

Cook, Deborah J.; Swinton, Marilyn; Toledo, Feli; Rose, Trudy; Hand-Breckenridge, Tracey; Boyle, Anne; Woods, Anne; Zytaruk, Nicole; Heels‐Ansdell, Diane; Sheppard, Robert

doi:10.7326/m15-0502

Cited by 91 publications

(111 citation statements)

References 23 publications

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“…In 2015, a multicentered, Canadian mixed-methods study defined a holistic, integrated palliative and spiritual care plan into critical care practice by defining a set of wishes to fulfillment for dying patients and their families [26]. This study represents emerging qualitative and quantitative studies in end-of-life care in the ICU that will ultimately inform clinical practice.…”

Section: Research Initiativesmentioning

confidence: 98%

End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine

Myburgh

Abillama

Chiumello

et al. 2016

Journal of Critical Care

102

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Section: Research Initiativesmentioning

confidence: 98%

End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine

Myburgh

Abillama

Chiumello

et al. 2016

Journal of Critical Care

102

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“…This is perhaps especially important during the dying phase of our patients. (13, 14) Despite benevolent intentions, we have created a culture in many ICUs that threatens patient ability to maintain dignity and return to the life they knew. An abundance of data summarized in the Pain Agitation Delirium (PAD) guidelines (15, 16) have emerged that provide a convincing evidence-based path for ICU clinicians to liberate patients efficiently and reliably from iatrogenic harm as they recover from critical illness.…”

Section: The “What” Of Icu Liberationmentioning

confidence: 99%

The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families

Ely

2017

Critical Care Medicine

395

163

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Over the past 20 years, critical care has matured in a myriad of ways resulting in dramatically higher survival rates for our sickest patients. For millions of new survivors comes de novo suffering and disability called the Post-Intensive Care Syndrome (PICS). Patients with PICS are robbed of their normal cognitive, emotional, and physical capacity and cannot resume their previous life. The ICU Liberation Collaborative is a real-world quality improvement (QI) initiative being implemented across 76 ICUs designed to engage strategically the ABCDEF bundle through team- and evidence-based care. This article explains the science and philosophy of liberating ICU patients and families from harm that is both inherent to critical illness and iatrogenic. ICU Liberation is an extensive program designed to facilitate implementation of the Pain, Agitation, and Delirium (PAD) guidelines, using the evidence-based ABCDEF Bundle. Participating ICU teams adapt data from hundreds of peer-reviewed studies to operationalize a systematic and reliable methodology that shifts ICU culture from the harmful inertia of sedation and restraints to an animated ICU filled with patients who are awake, cognitively engaged, and mobile with family members engaged as partners with the ICU team at the bedside. In so doing, patients are liberated from iatrogenic aspects of care that threaten her or his sense of self-worth and human dignity. The goal of this 2017 plenary lecture at the 47th SCCM Congress is to provide clinical ICU teams a synthesis of the literature that led to the creation of ICU Liberation philosophy and to explain how this patient- and family-centered, QI program is novel, generalizable, and practice-changing.

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“…Second, while the dying process will certainly have unwanted negatives in terms of pain and suffering (for which we advocate aggressive and much improved approaches to palliative care), the dying process can also be a time of existential and spiritual healing through growth in personal and relational wholeness as well as individual learning for patients, their loved ones, and those caring for them (13–15). Ending the patient’s life before the natural dying process runs its course potentially limits the opportunities for such healing at the end of life.…”

Section: Are There Patients For Whom Death Is Beneficial?mentioning

confidence: 99%

Physician-Assisted Suicide and Euthanasia in the ICU: A Dialogue on Core Ethical Issues*

Goligher

Ely

Sulmasy

et al. 2017

Critical Care Medicine

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Objective Many patients are admitted to the intensive care unit at or near the end of their lives. Consequently, the increasingly common debate regarding physician-assisted suicide and euthanasia (PAS/E) holds implications for the practice of critical care medicine. The objective of this manuscript is to explore core ethical issues related to PAS/E from the perspective of healthcare professionals and ethicists on both sides of the debate. Synthesis We identified four issues highlighting the key areas of ethical tension central to evaluating PAS/E in medical practice: (1) the benefit or harm of death itself, (2) the relationship between PAS/E and withholding or withdrawing life support, (3) the morality of a physician deliberately causing death, and (4) the management of conscientious objection related to PAS/E in the critical care setting. We present areas of common ground as well as important unresolved differences. Conclusions We reached differing positions on the first three core ethical questions and achieved significant agreement on how critical care clinicians should manage conscientious objections related to PAS/E. The alternative positions presented in this paper may serve to promote open and informed dialogue within the critical care community.

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Personalizing Death in the Intensive Care Unit: The 3 Wishes Project

Abstract: Hamilton Academy of Health Science Research Organization, Canadian Intensive Care Foundation.

Cited by 91 publications

References 23 publications

End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine

End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine

The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families

Physician-Assisted Suicide and Euthanasia in the ICU: A Dialogue on Core Ethical Issues*

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