US Physicians’ Opinions about Distinctions between Withdrawing and Withholding Life-Sustaining Treatment

Chung, Grace S.; Yoon, John D.; Rasinski, Kenneth A.; Curlin, Farr A.

doi:10.1007/s10943-015-0171-x

Cited by 50 publications

(33 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the literature, it has been shown that decisions of withholding are more frequent than withdrawing in ED as in our study . This could be explained by the fact that withdrawing life‐sustaining treatments was psychologically difficult and also more ethically problematic than withholding, as shown by Chung with US physicians . In a previous study, we demonstrated that these decisions were difficult for physicians who felt alone and overwhelmed during the decision‐making process and could be improved with systematic collegial reflection and specific training on end‐of‐life discussion …”

Section: Discussionmentioning

confidence: 73%

“…[2][3][4] This could be explained by the fact that withdrawing life-sustaining treatments was psychologically difficult and also more ethically problematic than withholding, as shown by Chung with US physicians. 19 In a previous study, we demonstrated that these decisions were difficult for physicians who felt alone and overwhelmed during the decisionmaking process and could be improved with systematic collegial reflection and specific training on end-of-life discussion. 20 Concerning reasons for making decisions of withholding or withdrawing life-sustaining treatments, we found that previous functional limitation and age were the most frequent criteria to justify limiting life-support therapies, whereas previous studies found that acute medical disorder was the principal criteria.…”

Section: Discussionmentioning

confidence: 88%

See 1 more Smart Citation

Difficulty of the decision‐making process in emergency departments for end‐of‐life patients

Douplat

Berthiller

Schott

et al. 2019

Evaluation Clinical Practice

View full text Add to dashboard Cite

Background In emergency departments, for some patients, death is preceded by a decision of withholding or withdrawing life‐sustaining treatments. This concerns mainly patients over 80, with many comorbidities. The decision‐making process of these decisions in emergency departments has not been extensively studied, especially for noncommunicating patients. Aim The purpose of this study is to describe the decision‐making process of withholding and withdrawing life‐sustaining treatments in emergency departments for noncommunicating patients and the outcome of said patients. Design We conducted a prospective multicenter study in three emergency departments of university hospitals from September 2015 to January 2017. Results We included 109 patients in the study. Fifty‐eight (53.2%) patients were coming from nursing homes and 52 (47.7%) patients had dementia. Decisions of withholding life‐sustaining treatment concerned 93 patients (85.3%) and were more frequent when a surrogate decision maker was present 61 (65.6%) versus seven (43.8%) patients. The most relevant factors that lead to these decisions were previous functional limitation (71.6%) and age (69.7%). Decision was taken by two physicians for 80 patients (73.4%). The nursing staff and general practitioner were, respectively, involved in 31 (28.4%) and two (1.8%) patients. A majority of the patients had no advance directives (89.9%), and the relatives were implicated in the decision‐making process for 96 patients (88.1%). Death in emergency departments occurred for 47 patients (43.1%), and after 21 days, 84 patients (77.1 %) died. Conclusion There is little anticipation in end‐of‐life decisions. Discussion with patients concerning their end‐of‐life wishes and the writing of advance directives, especially for patients with chronic diseases, must be encouraged early.

show abstract

Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 88%

Difficulty of the decision‐making process in emergency departments for end‐of‐life patients

Douplat

Berthiller

Schott

et al. 2019

Evaluation Clinical Practice

View full text Add to dashboard Cite

show abstract

“…[1,2] Religion has earlier been shown to have tremendous effect on end-of-life decisions. [16,18,19,21,26] We have previously shown that physicians had less faith in God and considered religion to be less influential in ethical decisions in 2015 than they did previously. [22] Thus, it is not surprising that an appointment with a minister shifted the treatment decisions to life-prolonging modalities less often in 2015 than in 1999.…”

Section: Factors Associated With Physicians' Decisionsmentioning

confidence: 92%

Has there been a change in the end-of-life decision-making over the past 16 years?

Piili

Lehto

Metsänoja

et al. 2019

BMJ Support Palliat Care

View full text Add to dashboard Cite

ObjectivesPhysicians’ decision-making in end-of-life (EOL) care includes many medical, ethical and juridical aspects. We studied the changes of these decisions over time and factors influencing them.MethodsA postal survey including two hypothetical patient scenarios was sent to 1258 Finnish physicians in 2015 and to 1182 in 1999. The attitudes, values and background factors of the physicians were also enquired.ResultsThe response rate was 56%. The physicians’ decisions to choose palliative approaches over active or intensive care increased from 1999 to 2015 when a terminally ill prostate cancer patient had probable iatrogenic gastrointestinal bleeding (53% vs 59%, p=0.014) and waited to meet his son (46% vs 60%, p<0.001) or a minister (53% vs 71%, p<0.001). Training in EOL care independently increased palliative approaches. Patient’s benefit (96% vs 99%, p=0.001), ethical values (83% vs 93%, p<0.001) and patient’s (68% vs 86%, p<0.001) or physician’s (44% vs 63%, p<0.001) legal protection were considered more influential to the decisions in 2015, while the family’s benefit was regarded as less influential to the decisions than it was in 1999 (37% vs 25%, p<0.001). Physicians were more willing to give a hospice voucher for an advanced breast cancer patient in 2015 (34% vs 58%, p<0.001).ConclusionsOur findings may reflect the transition to a stronger emphasis on patient-centred care and a stronger tendency to avoid futile therapies that have only short-term goals. The results highlight that education in all aspects of EOL care should be incorporated into the post-graduate training of medical specialties that take care of dying patients.

show abstract

“…This may be problematic for some bedside clinicians, particularly in the event that withdrawing mechanical ventilation is indicated during crisis standards of care. There are variations in physicians' perceptions of the ethical permissibility and psychological difficulty of withdrawing life support even under normal circumstances when the withdrawal is in-line with the patient's wishes for end of life care (Chung et al 2016). Unilateral decisions to withdraw life support are likely to be even less acceptable to these clinicians.…”

Section: Introductionmentioning

confidence: 99%

“We’re Not Ready, But I Don’t Think You’re Ever Ready.” Clinician Perspectives on Implementation of Crisis Standards of Care

Chuang

Cuartas

Powell

et al. 2020

AJOB Empirical Bioethics

View full text Add to dashboard Cite

Background: The COVID-19 pandemic has highlighted health care systems' vulnerabilities. Hospitals face increasing risk of periods of scarcity of life-sustaining resources such as ventilators for mechanical respiratory support, as has been the case in Italy as of March, 2020. The National Academy of Medicine has provided guidance on crisis standards of care, which call for the reallocation of scarce medical resources to those who will benefit most during extreme situations. Given that this will require a departure from the usual fiduciary duty of the bedside clinician, we determined and mapped potential barriers to the implementation of the guidelines from stakeholders using an implementation science framework. Methods: A protocol was created to operationalize national and state guidelines for triaging ventilators during crisis conditions. Focus groups and key informant interviews were conducted from July-September 2018 with clinicians at three acute care hospitals of an urban academic medical center. Respiratory therapists, intensivists, nursing leadership and the palliative care interdisciplinary team participated in focus groups. Key informant interviews were conducted with emergency management, respiratory therapy and emergency medicine. Subjects were presented the protocol and their reflections were elicited using a semi-structured interview guide. Data from transcripts and notes were categorized using a coding strategy based on the Theoretical Domains Framework. Results: Participants anticipated that implementing this protocol would challenge their roles and identities as clinicians including both their fiduciary duty to the patient and their decision-making autonomy. Despite this, many participants acknowledged the need for such a protocol to standardize care and minimize bias as well as to mitigate potential consequences for individual clinicians. Participants identified the question of considering patient quality of life in triage decisions as an important and unresolved ethical issue in disaster triage. Conclusion: Clinicians' discomfort with shifting roles and obligations could pose implementation barriers for crisis standards of care.

show abstract

US Physicians’ Opinions about Distinctions between Withdrawing and Withholding Life-Sustaining Treatment

Cited by 50 publications

References 37 publications

Difficulty of the decision‐making process in emergency departments for end‐of‐life patients

Difficulty of the decision‐making process in emergency departments for end‐of‐life patients

Has there been a change in the end-of-life decision-making over the past 16 years?

“We’re Not Ready, But I Don’t Think You’re Ever Ready.” Clinician Perspectives on Implementation of Crisis Standards of Care

Contact Info

Product

Resources

About