End-of-life dilemmas in the intensive care unit: <br /> Withholding and withdrawal of life sustaining treatment
Journal Title: Αρχεία Ελληνικής Ιατρικής - Year 2010, Vol 27, Issue 1
Abstract
Intensive care may prolong the dying process in patients who have been unresponsive to the treatment provided and for whom the possibility of survival or regaining an acceptable quality of life is nil. The withholding and withdrawal of life-sustaining treatment were introduced to avoid the futile suffering of dying patients. These practices are based on the principles of bioethics; they are common worldwide and have been approved by the international scientific community. They must not be confused with euthanasia. There is no ethical distinction between withholding and withdrawal of treatment. Any life-sustaining modality can be withheld or withdrawn, including artificial nutrition and hydration. The great majority of patients in intensive care units (ICU) are incapacitated. Advance directives may extend the autonomy of patients. Medical societies recommend a model of shared decision making, in which the medical team and the relatives share the responsibility for decisions. The goals of treatment are determined through a procedure of discussion and information exchange. When treatment cannot fulfill its defined goals, it is considered non-beneficial and is withheld/withdrawn. Conflicts may arise, in which case, an effort to improve communication is needed. Unsolved disagreements are referred to the hospital ethics committee. Observational studies conducted in several countries on different continents showed that a large proportion of ICU deaths are preceded by withholding/ withdrawal of treatment, and that a variety of clinical factors are associated with the decision to limit treatment. The frequency of withholding/withdrawal of treatment and the degree of involvement of relatives in the decision making are influenced by the cultural context.
Authors and Affiliations
G. KRANIDIOTIS, V. GEROVASILI, A. TASOULIS, S. NANAS
Keywords
Related Articles
- EP ID EP155034
- DOI -
- Views 70
- Downloads 0
Epidemiology of acute coronary syndromes in Greece:<br /> Aims, design and baseline characteristics of the Greek study of acute coronary syndromes (GREECS)
OBJECTIVE The Greek study of acute coronary syndromes (GREECS) was conducted in order to evaluate the annual incidence of acute coronary syndromes (ACS) and to delineate the role of clinical, biochemical, lifestyle and b...
Organizational culture of physicians on the island of Crete
OBJECTIVE To identify the organizational culture profile, as experienced by physicians, overall and in the various levels of health care facilities in Crete. METHOD A cross-sectional study was conducted with a sample...
Bronchiolitis obliterans organizing pneumonia (BOOP)
No abstarct available
Atrioventricular nodal reentrant tachycardia (AVNRT)
NO abstract available
Measuring the quality of life and the European health model
The purpose of this study is to discuss the European health model and explore its relevance to measurement and evaluation of quality of life. The notion of social quality is discussed and empirical evidence is presented...