Increasing incidence of withholding and withdrawal of life support from the critically ill

American Journal of Respiratory and Critical Care Medicine
T J Prendergast, J M Luce

Abstract

To determine whether limits to life-sustaining care are becoming more common, we attempted to quantify the incidence of recommendations to withhold or withdraw life support from critically ill patients, to describe how patients respond to these recommendations, and to examine how conflicts over these recommendations are resolved. In 1992 and 1993 we prospectively enrolled 179 consecutive patients from two intensive care units (ICUs) for whom a recommendation was made to withhold or withdraw life support. Where possible, we compared results with data collected in the same units over a similar time period in 1987 and 1988. Recommendations to withhold or withdraw life support preceded 179 of 200 deaths (90%) in 1992 and 1993, compared with 114 of 224 deaths (51%) in 1987 and 1988 (chi2 = 73.76, p < 0.001]. Cardiopulmonary resuscitation was initiated in 10% of deaths in 1992 and 1993 as compared with 49% in 1987 and 1988. Ninety percent of patients agreed within less than 5 d, and only eight patients (4%) refused physicians' recommendations to limit life support. In cases of conflict, physicians in 1992 and 1993 deferred to patients with one exception: physicians were willing to refuse surrogate requests for resuscitation of patien...Continue Reading

Citations

Jun 17, 1999·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·R I HallG Rocker
Jun 16, 2004·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Graeme M RockerChristopher J O'Callaghan
Jun 16, 2004·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Richard I HallDawnelda Murray
Dec 3, 2004·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Tasnim SinuffUNKNOWN Level of Care Study Investigators & the Canadian Critical Care Trials Group
Dec 25, 2007·Intensive Care Medicine·Hans-Henrik BülowMitchell M Levy
Oct 14, 2008·Intensive Care Medicine·Elie AzoulayUNKNOWN SAPS 3 investigators
Jan 26, 2011·Intensive Care Medicine·Li WengUNKNOWN Chinese Critical Care Ethics Group
Feb 11, 2012·Intensive Care Medicine·Elie AzoulayJean-François Timsit
Jun 25, 2008·Journal of General Internal Medicine·R Brac SelphDouglas B White
Jul 18, 2008·Journal of General Internal Medicine·Pascale C GruberOi Ting Yu
Dec 21, 2000·Current Oncology Reports·J D Cowan
Dec 2, 2000·The American Journal of Medicine·J M Luce
Mar 3, 2004·The Annals of Thoracic Surgery·John E PillingDavid A Waller
Nov 28, 2001·International Journal of Nursing Studies·Ursula DaweStacey A Page
Jun 2, 1998·Lancet·E J Emanuel, L L Emanuel
Jan 22, 2002·Journal of the American College of Surgeons·Anne C MosenthalJoan Huffman
Apr 15, 2003·Journal of the American College of Surgeons·Daniel B HinshawJames Hallenbeck
Aug 30, 2003·Journal of the American College of Surgeons·Anne C Mosenthal, Patricia A Murphy
Apr 28, 2007·European Journal of Anaesthesiology·N FranchittoD Rouge
Mar 14, 2002·Journal of the American Geriatrics Society·M AnkromW B Greenough
Apr 12, 2002·Journal of the American Geriatrics Society·Thomas E Finucane
Sep 19, 2003·The New England Journal of Medicine·Deborah CookUNKNOWN Level of Care Study Investigators and the Canadian Critical Care Trials Group
Feb 23, 2013·The American Journal of Bioethics : AJOB·Samuel M BrownRobert Paine
Jan 19, 2002·Journal of Palliative Medicine·D SineC F von Gunten
Dec 14, 2004·Journal of Palliative Medicine·UNKNOWN American Academy of Hospice and Palliative MedicineUNKNOWN National Hospice and Palliative Care Organization
Dec 15, 2005·Journal of Palliative Medicine·Lewis CohenJames Cleary
Sep 1, 2005·Journal of Palliative Medicine·J Randall Curtis, Gordon D Rubenfeld
Feb 28, 2006·Journal of Palliative Medicine·J Randall Curtis
Sep 7, 2007·Journal of Palliative Medicine·Andrew J McCormickJ Randall Curtis
Jul 15, 2009·Journal of Palliative Medicine·Karin Porter-WilliamsonSteven Stites
May 15, 2012·Journal of Palliative Medicine·Sangeeta LambaScott Compton
Oct 4, 2012·Journal of Palliative Medicine·Leah SmithHubert Chen
Apr 30, 2013·Journal of Palliative Medicine·Jacqueline K YuenM Carrington Reid
Oct 3, 2013·Journal of Palliative Medicine·Thanh N HuynhNeil S Wenger
Mar 24, 2011·Annals of Oncology : Official Journal of the European Society for Medical Oncology·D HaukeE C Winkler
Apr 11, 2003·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Alan S Kliger, Fredric O Finkelstein
Mar 3, 2001·The American Journal of Nursing·M FerrinS H Kagan
Dec 13, 2005·Journal of Nursing Care Quality·Vicki A LindgrenRobert L Bloom
Apr 16, 2002·Academic Medicine : Journal of the Association of American Medical Colleges·David E Weissman, Susan D Block

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