Implementation of ICU palliative care guidelines and procedures: a quality improvement initiative following an investigation of alleged euthanasia

Chest
Ware G KuschnerStephen C Ezeji-Okoye

Abstract

Ethical conflicts are commonly encountered in the course of delivering end-of-life care in the ICU. Some ethical concerns have legal dimensions, including concerns about inappropriate hastening of death. Despite these concerns, many ICUs do not have explicit policies and procedures for withdrawal of life-sustaining treatments. We describe a US Office of Inspector General (OIG) investigation of end-of-life care practices in our ICU. The investigation focused on care delivered to four critically ill patients with terminal diseases and an ICU nurse's concern that the patients had been subjected to euthanasia. The OIG investigation also assessed the validity of allegations that patient flow in and out of our ICU was inappropriately influenced by scheduled surgeries and that end-of-life care policies in our ICU were not clear. Although the investigation did not substantiate the allegations of euthanasia or inappropriate ICU patient flow, it did find that the policies that discuss end-of-life care issues were not clear and allowed for wide-ranging interpretations. Acting on the OIG recommendations, we developed a quality improvement initiative addressing end-of-life care in our ICU, intended to enhance communication and understanding...Continue Reading

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Citations

Oct 27, 2009·Current Opinion in Critical Care·Kristen G Schaefer, Susan D Block
Jun 6, 2009·Chest·Mohamed Y RadyJoan L McGregor
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Dec 17, 2009·The American Journal of Hospice & Palliative Care·Mohamed Y Rady, Joseph L Verheijde
Oct 2, 2020·Medizinische Klinik, Intensivmedizin und Notfallmedizin·K Lenz

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