Withholding and withdrawing life-sustaining treatment: a comparative study of the ethical reasoning of physicians and the general public

Rydvall, A.; Lynøe, Niels

doi:10.1186/cc6786

Cited by 47 publications

(39 citation statements)

References 18 publications

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“…They reported that participating nurses believed that a patient has the right to refuse these treatments. [11][12][13] Some studies [11,14,15] assessed physician's attitude towards LSTs in Sweden, and stated that physicians have a general positive attitude towards limited use of life-sustaining treatment for a good death.…”

Section: Introductionmentioning

confidence: 99%

Critical care nurses' attitude towards life-sustaining treatments in South East Iran

Razban

Iranmanesh

Aliabadi

et al. 2016

World Journal of Emergency Medicine

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BACKGROUND: Life-sustaining treatments (LSTs) may prolong life but greatly decrease the quality of death. One factor influencing decision-making about withholding and withdrawing these treatments is the attitude of nurses. This study aimed to evaluate the attitude of critical care nurses towards life-sustaining treatments in South East Iran. METHODS:In this cross-sectional study, "Ethnicity and Attitudes towards Advance Care Directives Questionnaire" was used to investigate the attitude of 104 critical care nurses towards lifesustaining treatments in three hospitals affi liated to Kerman University of Medical Sciences. RESULTS:The fi ndings of this study indicated that although a majority of critical care nurses (77%) did not have personal desire for use of LSTs including CPR and mechanical ventilation, they had moderately negative to neutral attitude towards general use of LSTs (2.95 of 5).CONCLUSIONS: These fi ndings suggest that nurses' attitude towards LSTs can be changed by inclusion of specific courses about death, palliative care and life-sustaining treatments in undergraduate and postgraduate nursing curricula. Educating Muslim nurses about religious aspects of LSTs may also improve their attitudes.

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Section: Introductionmentioning

confidence: 99%

Critical care nurses' attitude towards life-sustaining treatments in South East Iran

Razban

Iranmanesh

Aliabadi

et al. 2016

World Journal of Emergency Medicine

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“…Patients do not like to confront their mortality 17 and desire for the CPR differs between healthcare professionals, patients and families. 2,3 Finally, the portrayal of cardiopulmonary resuscitation by the media tends to be unhelpful and unrealistic. There is lot to be gained by advance care planning leading to better management of end of life and better mental health outcomes for the surviving family members.…”

Section: Communication At the End Of Lifementioning

confidence: 99%

“…Perceived appropriateness of interventions such as resuscitation differs significantly between healthcare professionals and patients and families, with patients and their relatives being more keen on life-prolonging interventions, without consideration being given to the associated quality of the saved life. 2,3 For example, patients with lung cancer have a high mortality when admitted to ICU. 4 The need for organ support and concomitant sepsis usually preclude oncological interventions such as chemotherapy and radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

Classic cases revisited: Mrs Janet Tracey, resuscitation and the importance of good communication

Szawarski

2015

Journal of the Intensive Care Society

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The prevalence of inappropriate care, defined as actions contrary to personal and professional beliefs, is high. This is a reflection of the reluctance of the society at large to acknowledge the biological certainty that is death. The case of Mrs Janet Tracey illustrates importance of good communication at the end of life, and the difficulties associated with making of DNACPR decisions. The case brings together two bioethical perspectives on the relationship between the patient and the physician namely the rights based approach, as emphasised by the Article 8 of the European Convention on Human Rights and the bioethical principles approach ephasising autonomy. In doing so it creates a medico-legal landmark for all those involved in management of the end of life.

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“…Different hospitals have different practices,48 possibly related to the use of time-limited treatment trials. Doctors are more likely to withhold or withdraw treatment than members of the public, except in the most severely affected patients 49. In the Netherlands, if the doctor decides a treatment is futile then it is stopped, and there is no routine involvement of a legal process 50…”

Section: Introductionmentioning

confidence: 99%

Using best interests meetings for people in a prolonged disorder of consciousness to improve clinical and ethical management

Wade

2017

J Med Ethics

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Current management of people with prolonged disorders of consciousness is failing patients, families and society. The causes include a general lack of concern, knowledge and expertise; a legal and professional framework which impedes timely and appropriate decision-making and/or enactment of the decision; and the exclusive focus on the patient, with no legitimate means to consider the broader consequences of healthcare decisions. This article argues that a clinical pathway based on the principles of (a) the English Mental Capacity Act 2005 and (b) using time-limited treatment trials could greatly improve patient management and reduce stress on families. There needs to be early and continuing use of formal best interests meetings, starting between 7 and 21 days after onset of unconsciousness (from any cause, including progressive disorders). The treatment options need to evolve as the clinical state and prognosis becomes more certain. A formal discussion of treatment withdrawal should occur when the upper bound of predicted recovery falls below a level the patient would have considered acceptable, and it should always be discussed when the condition is considered permanent. Any decision to stop treatment should be contingent on a formal second opinion from an independent expert who should review the clinical situation and expected prognosis, but not the best interests decision. The article also asks how, if at all, the adverse effects on the family and the resource implications of long-term care of people left in a prolonged state of unconsciousness should be incorporated in the process.

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Withholding and withdrawing life-sustaining treatment: a comparative study of the ethical reasoning of physicians and the general public

Abstract: Background Our objective was to investigate whether a consensus exists between the general public and health care providers regarding the reasoning and values at stake on the subject of life-sustaining treatment.

Cited by 47 publications

References 18 publications

Critical care nurses' attitude towards life-sustaining treatments in South East Iran

Critical care nurses' attitude towards life-sustaining treatments in South East Iran

Classic cases revisited: Mrs Janet Tracey, resuscitation and the importance of good communication

Using best interests meetings for people in a prolonged disorder of consciousness to improve clinical and ethical management

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