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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2019

Open Access 01-12-2019 | Emergency Medicine | Review

Withholding and withdrawing life-support in adults in emergency care: joint position paper from the French Intensive Care Society and French Society of Emergency Medicine

Authors: Jean Reignier, Anne-Laure Feral-Pierssens, Thierry Boulain, Françoise Carpentier, Pierrick Le Borgne, Denis Del Nista, Gilles Potel, Sandrine Dray, Delphine Hugenschmitt, Alexandra Laurent, Agnès Ricard-Hibon, Thierry Vanderlinden, Tahar Chouihed, For the French Society of Emergency Medicine (Société Française de Médecine d’Urgence, SFMU) and French Intensive Care Society (Société de Réanimation de Langue Française, SRLF)

Published in: Annals of Intensive Care | Issue 1/2019

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Abstract

For many patients, notably among elderly nursing home residents, no plans about end-of-life decisions and palliative care are made. Consequently, when these patients experience life-threatening events, decisions to withhold or withdraw life-support raise major challenges for emergency healthcare professionals. Emergency department premises are not designed for providing the psychological and technical components of end-of-life care. The continuous inflow of large numbers of patients leaves little time for detailed assessments, and emergency department staff often lack training in end-of-life issues. For prehospital medical teams (in France, the physician-staffed mobile emergency and intensive care units known as SMURs), implementing treatment withholding and withdrawal decisions that may have been made before the acute event is not the main focus. The challenge lies in circumventing the apparent contradiction between the need to make immediate decisions and the requirement to set up a complex treatment project that may lead to treatment withholding and/or withdrawal. Laws and recommendations are of little assistance for making treatment withholding and withdrawal decisions in the emergency setting. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and French Society of Emergency Medicine (Société Française de Médecine d’Urgence, SFMU) tasked a panel of emergency physicians and intensivists with developing a document to serve both as a position paper on life-support withholding and withdrawal in the emergency setting and as a guide for professionals providing emergency care. The task force based its work on the available legislation and recommendations and on a review of published studies.
Footnotes
1
Patient confined to bed or chair, with severe cognitive dysfunction, requiring continuous care from others; or dying patient.
 
2
Patient confined to bed or chair, with some residual cognitive function, requiring assistance for most daily activities; or patient with dementia who can move around but must be watched at all times.
 
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Metadata
Title
Withholding and withdrawing life-support in adults in emergency care: joint position paper from the French Intensive Care Society and French Society of Emergency Medicine
Authors
Jean Reignier
Anne-Laure Feral-Pierssens
Thierry Boulain
Françoise Carpentier
Pierrick Le Borgne
Denis Del Nista
Gilles Potel
Sandrine Dray
Delphine Hugenschmitt
Alexandra Laurent
Agnès Ricard-Hibon
Thierry Vanderlinden
Tahar Chouihed
For the French Society of Emergency Medicine (Société Française de Médecine d’Urgence, SFMU) and French Intensive Care Society (Société de Réanimation de Langue Française, SRLF)
Publication date
01-12-2019
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2019
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-019-0579-7

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