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5 December 2000 | Volume 133 Issue 11 | Pages 886-893
End-of-life care of patients in the intensive care unit (ICU) often requires dramatic shifts in attitudes and interventions, from traditional intensive rescue care to intensive palliative care. The care of patients dying in ICUs raises both clinical and ethical difficulties. Because fewer ICU patients are able to make decisions about withdrawing treatment, careful attention must be paid to previously expressed preferences and surrogate input. Cultural and spiritual values of patients and families may differ markedly from those of clinicians. Although prognostic models are increasingly able to predict mortality rates for groups of ICU patients, their usefulness in guiding specific decisions to forgo treatment has not been established. When a decision to forgo treatment is made, the focus should be on specifying the patient's goals of care and assessing all treatments in light of these goals; interventions that do not contribute to the patient's goals should be discontinued. Symptoms accompanying withdrawal of life support can almost always be controlled with appropriate palliative measures. After ICU interventions are forgone, patient comfort must be the paramount objective. Whether in the ICU or elsewhere, hospitals have an ethical obligation to provide settings that offer dignified, compassionate, and skilled care.
Author and Article Information
for the ACP–ASIM End-of-Life Care Consensus Panel
This paper was written by Kathy Faber-Langendoen, MD, and Paul N. Lanken, MD, and was developed for the American College of Physicians–American Society of Internal Medicine (ACP–ASIM) End-of-Life Care Consensus Panel. Members of the ACP–ASIM End-of-Life Care Consensus Panel were Bernard Lo, MD (Chair); Janet Abrahm, MD; Susan Block, MD; William Breitbart, MD; Ira R. Byock, MD; Kathy Faber-Langendoen, MD; Lloyd W. Kitchens Jr., MD; Paul Lanken, MD; Joanne Lynn, MD; Diane Meier, MD; Timothy E. Quill, MD; George Thibault, MD; and James A. Tulsky, MD. Primary staff to the panel were Lois Snyder, JD (Project Director), and Jason Karlawish, MD (Clinical Staff). The paper was reviewed by the Education Committee and was reviewed and approved by the Ethics and Human Rights Committee, although it does not represent official College policy. Members of the Ethics and Human Rights Committee were Risa Lavizzo-Mourey, MD (Chair); Joanne Lynn, MD; Richard J. Carroll, MD; David A. Fleming, MD; Steven H. Miles, MD; Gail J. Povar, MD; James A. Tulsky, MD; Alan L. Gordon, MD; Siang Y. Tan, MD; Vincent Herrin, MD; and Lee J. Dunn Jr., LLM.
Requests for Single Reprints: Lois Snyder, JD, Center for Ethics and Professionalism, American College of Physicians–American Society of Internal Medicine, 190 North Independence Mall West, Philadelphia, PA 19106; e-mail, lsnyder{at}mail.acponline.org.
Current Author Addresses: Dr. Faber-Langendoen: State University of New York Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210.
Dr. Lanken: University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104. ACADEMIA AND CLINIC
Dying Patients in the Intensive Care Unit: Forgoing Treatment, Maintaining Care
From the State University of New York Upstate Medical University, Center for Bioethics and Humanities, Syracuse, New York; and the University of Pennsylvania Pulmonary, Allergy, and Critical Care Division and Center for Bioethics, Philadelphia, Pennsylvania.
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