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Limitation of life support in the critically ill: the Hong Kong perspective
1Department of Anaesthesia and Intensive Care, The Prince of Wales Hospital, Shatin, Hong Kong SAR.
Insights
Limiting life support for critically ill Chinese patients in intensive care units (ICUs) is common and ethically accepted. Patients and families largely agree with these decisions, highlighting the importance of communication and shared decision-making.
Area of Science:
- Medical Ethics
- Intensive Care Medicine
- Cross-Cultural Healthcare
Background:
- Life support in intensive care units (ICUs) may prolong suffering without benefit.
- Ethical guidelines for limiting life support are primarily Western-based.
- Limited data exists on end-of-life decision-making in Asian intensive care settings.
Purpose of the Study:
- To review the processes of limiting life support in critically ill Chinese patients in Hong Kong.
- To explore cultural factors influencing end-of-life care decisions in Asian intensive care units.
Main Methods:
- Literature review of local and international research and opinions.
- Analysis of decision-making processes for life support limitation.
Main Results:
- Limitation of life support occurs in 23-61% of deceased critically ill Chinese patients in ICUs.
- Relatives desire involvement in decisions regarding life support limitation.
- Factors important to relatives include staff caring attitude, information provision, and treatment competence.
Conclusions:
- Limitation of therapy is prevalent in ICUs for dying Chinese patients.
- Patient and relative agreement with medical decisions reaches 95%.
- Communication and shared decision-making are crucial, showing similarities with Western expectations.
Introduction:
Patients admitted to the intensive care unit (ICU) may not benefit from the life support provided and it may result in prolonged and unnecessary suffering. Limiting life-support therapy in this situation is an ethically acceptable practice in Western countries. Statements produced by professional bodies have been generally made from a Western perspective. Cultural influences, aspects of management and resource limitations may create differences, yet there is little information available on the ethical decision making processes involved in limitation of life support in Asian countries. This article reviews the processes involved in the limitation of life support in critically ill intensive care patients in the predominantly Chinese population of Hong Kong.
Methods:
Direct and computerised search of locally available and international published research articles and opinions.
Results:
Limitation of life-support therapy occurs in 23% to 61% of critically ill Chinese patients that die within the ICU which is comparable to figures presented in the Western literature. Relatives wish to be part of the decision making process when limitation of therapy is to be considered. A staff attitude of caring towards patient and family, a need for information from the doctor and staff, and competence in providing adequate treatment have been identified as important factors by relatives when limitation of life-support therapy was being discussed.
Conclusions:
Limitation of therapy in dying Chinese patients occurs in ICUs and, patients and relatives concur in 95% of cases with medical decisions to limit therapy in these patients. The importance of communication as well as a desire to participate in the decision-making process regarding limitation of therapy suggest similarities between Western and Asian expectations. More comprehensive data are required regarding end-of-life issues in the Asian context, especially in relation to the general population's perception as to the processes involved.
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