Making good death more accessible: end-of-life care in the intensive care unit

Excerpt

Despite advances in critical care medicine, decisions and communications about withholding or withdrawing life-sustaining interventions are routine for intensive care unit (ICU) physicians who attend critically ill patients [1]. Nonetheless, the quality of the dying process and ICU physicians’ comfort in discussing end-of-life issues with families vary not only across the globe but also within a region. In a large-scale study on the practices of ICU physicians in Asia who manage critically ill patients [2], respondents reportedly often withheld but seldom withdrew life-sustaining treatments at the end-of-life, although variations in attitudes and practice exist across countries and regions. Using the data from that study, Phua et al. [3] report in a recent article how regional economic status in particular has a significant impact on ICU physicians’ attitudes regarding withholding or withdrawing life-sustaining interventions for end-of-life patients. Physicians in low-middle income countries were less likely to withhold and withdraw resource-intensive and invasive interventions (e.g. cardiopulmonary resuscitation, mechanical ventilation and vasopressors and inotropes, tracheostomy and haemodialysis), although they were more likely to forego less aggressive interventions (e.g. enteral nutrition, intravenous fluid therapy, oral suctioning). These physicians, who are more inclined to accede to families’ requests to withdraw life-sustaining treatments on financial grounds, are nevertheless more agreeable to follow families’ demands to continue these interventions, possibly out of their perceived legal risks associated with a lack of policies and ethical guidance on limiting and overriding family requests for non-beneficial treatments [3]. …