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'End-of-life' decision making within intensive care--objective, consistent, defensible?
1General Infirmary at Leeds, Department of Anaesthesia and Intensive Care, Great George Street, Leeds, LS1 3EX.
Journal of Medical Ethics
|December 29, 2000
Summary
Decisions regarding life-prolonging treatments in intensive care lack consistency and objectivity, causing staff unease. Improving care consistency and communication is vital for patient protection and staff well-being.
Area of Science:
- Medical Ethics
- Intensive Care Medicine
- Nursing Management
Background:
- Life-prolonging procedures in intensive care units (ICUs) involve complex ethical and clinical decisions.
- Variability in decision-making processes can impact patient care and staff morale.
Purpose of the Study:
- To assess objectivity, consistency, and professional agreement in initiating, continuing, and withdrawing life-prolonging treatments.
- To explore staff unease regarding the legality, morality, and defensibility of these procedures.
- To examine methods, timelines, and communication strategies for treatment withdrawal.
Main Methods:
- A structured questionnaire was administered to clinical nurse managers.
- The study encompassed all intensive care units within the Yorkshire region.
Main Results:
- The survey revealed significant inconsistencies and a lack of objectivity in decision-making processes.
- A notable degree of professional unease among ICU staff was reported.
Conclusions:
- There is a critical need for enhanced consistency in patient care before and during ICU admission.
- Comprehensive audits can promote objective, defensible decisions and informed choices.
- Open dialogue and improved communication are essential to reduce staff stress related to end-of-life care decisions.