End-of-life decision-making in the ICU
Palliative medicine and end-of-life decision-making are new, rapidly developing aspects of modern medicine. There are some limitations and differences in the setting of intensive care units (ICU), mainly because of the rate of progression of the patient's condition and the patient's limited ability to make decisions for themselves. The end-of-life decision (EOLD) should always be performed individually. In this algorithm, you will become a doctor dealing with two different patients at the end of their lives. We will introduce you to the basics and general principles of end-of-life decision-making in the ICU.
Review
Most patients admitted to the intensive care unit (ICU) will survive their critical illness with advanced and high-technical treatments. In 10-20% of patients the medical situation deteriorates leading to an inevitable death. The actual risk of death depends on the underlying disease and may surpass 50% in high-risk ICU patients. Withholding and/or withdrawing life-sustaining measures in those patients has become common practice preceding death among patients in ICUs worldwide.
The algorithm offers model situations of decisions that has to be made in a process of a patient’s deterioration. It is valuable to reflect on our own choices and compare with answers based on data and scientific guidelines. ICU healthcare professionals need to take time for the ‘right conversation’ with (if possible) the patient and the family members on wishes and appropriate comfort care. These illustrative virtual patient cases help to manage end-of-life situations in the ICU.
Sources
KUŘE, Josef. Journal of Medical Law and Bioethics. Journal of Medical Law and Bioethics. 2020, 2020(2/2020), 84-104. ISSN 1804-8137.
COCORADAZZI, Ana L et al. Palliative withdrawal ventilation: why, when and how to do it? Hospice and Palliative Medicine International Journal. 2019, ver. 3, no. 1. DOI: 10.15406/hpmij.2019.03.00141
DOPORUČENÍ PŘEDSTAVENSTVA ČLK č. 1/2010: k postupu při rozhodování o změně léčby intenzivní na léčbu paliativní u pacientů v terminálním stavu, kteří nejsou schopni vyjádřit svou vůli. 2010.
MERCADANTE, Sebastiano, Cesare GREGORETTI a Andrea CORTEGIANI. Palliative care in intensive care units: why, where, what, who, when, how. BMC Anesthesiology. 2018, year 18, no. 1. DOI: 10.1186/s12871-018-0574-9
PAN, Hongyan et al. Palliative Care in the Intensive Care Unit: Not Just End-of-life Care. Intensive Care Research. 2022, ver. 3, no. 1. DOI: 10.1007/s44231-022-00009-0
Learning targets
2. The student defines the terms full treatment, comfort therapy, withholding, and withdrawal of treatment.
3. The student understands the concept of shared decision-making in end-of-life decisions.
Key points
2. Adequate information is always needed to decide the level of therapy.
3. The changes in the treatment plan decision should be precisely documented.
