The Durban World Congress Ethics Round Table Conference Report: I. Differences between withholding and withdrawing life-sustaining treatments

Sprung, Charles L.; Paruk, Fathima; Kissoon, Niranjan; Hartog, Christiane S.; Lipman, Jeffrey; Du, Bin; Argent, Andrew C.; Hodgson, RE; Guidet, Bertrand; Groeneveld, A. B. Johan; Feldman, Charles

doi:10.1016/j.jcrc.2014.06.022

Cited by 38 publications

(18 citation statements)

References 63 publications

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“…A World Congress Ethics Round Table Conference was held to identify the main position of physicians of intensive and critical care medicine about the withholding/withdrawal of life-sustaining treatment [ 11 ]. Most respondents at the conference stated that there was no difference between withholding and withdrawing life-sustaining treatment in patients with terminal disease.…”

Section: Ethical Concerns For the Withholding Or Withdrawal Of Hemodimentioning

confidence: 99%

Hemodialysis as a life-sustaining treatment at the end of life

Shin

Lee

2018

Kidney Res Clin Pract.

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The Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life came into effect on February 4th, 2018, in South Korea. Based on the Act, all Koreans over the age of 19 years can decide whether to refuse life-sustaining treatments at the end of life via advance directive or physician orders. Hemodialysis is one of the options designated in the Act as a life-sustaining treatment that can be withheld or withdrawn near death. However, hemodialysis has unique features. So, it is not easy to determine the best candidates for withholding/withdrawing hemodialysis at the end of life. Thus, it is necessary to investigate the meaning and implications of hemodialysis at the end of life with ethical consideration of futility and withholding or withdrawal of intervention.

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Section: Ethical Concerns For the Withholding Or Withdrawal Of Hemodimentioning

confidence: 99%

Hemodialysis as a life-sustaining treatment at the end of life

Shin

Lee

2018

Kidney Res Clin Pract.

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“…Third, there was the measurement issue because most variables related to EOL care were dichotomized to yes or no answers. Especially, advance care planning includes various forms, such as living wills and POLST, and LSTs include various treatments, such as cardiopulmonary resuscitation, ventilator care, endotracheal intubation, chemotherapy, dialysis, feeding tube, and use of antibiotics [4,14,19]. Therefore, the findings of this study cannot be generalized to all aspects of EOL decision making.…”

Section: Discussionmentioning

confidence: 94%

“…The definition of withholding Life-Sustaining Treatments (LSTs) is "a decision not to start or increase a lifesustaining intervention (p. 1164)" [3]. LSTs should generally be withheld or withdrawn after obtaining the consent of patients, their loved ones (i.e., spouses, children, and relatives/friends), and health care proxies if there is no hope of recovery or if terminally ill patients do not want to prolong their lives [4]. In a study, prior to hospitalization, only 11.9% of patients preferred to receive LSTs [5].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with the Decision to Withhold Life-Sustaining Treatments among Middle-Aged and Older Adults Who Die in Hospital

Cheon

2018

Korean J Adult Nurs

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Purpose: As advanced medical care has resulted in the unintended consequence of prolonging deaths, there is a growing interest in the decision to withhold life-sustaining treatments. The purpose of this study was to determine factors associated with the decision to withhold life-sustaining treatments in middle-aged and older adults who die in hospital in the United States. Methods: This cross-sectional correlational study conducted secondary analysis of 2000-2012 exit interview data from the Health and Retirement Study. Adults aged 50 and older who died in hospital and who had made a decision regarding life-sustaining treatments were included. Multivariable logistic regression was used to identify factors related to the decision to withhold life-sustaining treatments. Results: Among 1,412 adults, the prevalence of the decision to withhold life-sustaining treatments was 61.1%. Significant factors associated with the decision to withhold life-sustaining treatments were being African American (Adjusted Odds Ratio [AOR]=0.50, 95% Confidential Interval [CI]=0.30~0.86), Catholic (AOR=0.5, 95% CI=0.32~0.93), having at least one private insurance policy (AOR=1.40, 95% CI=1.02~1.92), having a living will (AOR=1.71, 95% CI=1.04~2.83), and having discussed end-of-life care with someone (AOR=1.810, 95% CI=1.25~2.62). Conclusion: Differences in race and religious affiliation should be considered when older adults, family members, and health care providers make decisions regarding life-sustaining treatments at the end-of-life. Also, health insurance coverage for advance care planning makes it easier for people to discuss life-sustaining treatments with health care providers.

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“…Some families may be unwilling to acquiesce to a decision to stop life support. This is a particular challenge for religious or cultural groups that traditionally do not accept withdrawal of treatment 14. However, there is no ethical difference between withholding and withdrawing life-sustaining treatment 15.…”

Section: What Should Resuscitation Guidelines Recommend?mentioning

confidence: 99%