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Decisions to limit life-sustaining treatment for critically ill patients who lack both decision-making capacity and surrogate decision-makers.
| Content Provider | Semantic Scholar |
|---|---|
| Author | White, Douglas B. Curtis, J. R. Lo, Bernard Luce, John M. |
| Copyright Year | 2006 |
| Abstract | OBJECTIVE Many intensive care unit (ICU) physicians have withdrawn life-support from a patient who lacked decision-making capacity and a surrogate decision-maker, yet little is known about the decision-making practices for these patients. We sought to determine how often such patients are admitted to the ICU of a metropolitan hospital and how end-of-life decisions are made for them. DESIGN Prospective, observational cohort study. PATIENTS AND SETTING Consecutive adult patients admitted to the medical ICU of a metropolitan West Coast hospital during a 7-month period in 2003 to 2004. MEASUREMENTS Attending physicians completed a questionnaire about the decision-making process for each patient for whom they considered limiting life-support who lacked decisional capacity and a legally recognized surrogate decision-maker. MAIN RESULTS Of the 303 patients admitted during the study period, 49 (16%; 95% confidence interval [CI], 12-21%) lacked decision-making capacity and a surrogate during the entire ICU stay. Compared with all other ICU patients, these patients were more likely to be male (88% vs. 69%; p = .002), white (42% vs. 23%; p = .028), and > or =65 yrs old (29% vs. 13%; p = .007). Physicians considered withholding or withdrawing treatment from 37% (18) of the 49 patients who lacked both decision-making capacity and a surrogate decision-maker. For 56% (10) of these 18 patients, the opinion of another attending physician was obtained; for 33% (6 of 18), the ICU team made the decision independently, and for 11% (2 of 18), the input of the courts or the hospital ethics committee was obtained. Overall, 27% of deaths (13 of 49) during the study period were in incapacitated patients who lacked a surrogate (95% CI, 15-41%). CONCLUSIONS Sixteen percent of patients admitted to the medical ICU of this hospital lacked both decision-making capacity and a surrogate decision-maker. Decisions to limit life support were generally made by physicians without judicial or institutional review. Further research and debate are needed to develop optimal decision-making strategies for these difficult cases. |
| Starting Page | 030102 |
| Ending Page | 030102 |
| Page Count | 1 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://www.childrenshospital.org/~/media/1807EEFB649D464585418AC70D7B14A6.ashx |
| PubMed reference number | 16763515v1 |
| Volume Number | 34 |
| Issue Number | 8 |
| Journal | Critical care medicine |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Cessation of life Confidence Intervals Critical Illness Decision Making Forty Nine Hospital admission Patients Sixty Nine court intensive care unit life support |
| Content Type | Text |
| Resource Type | Article |
