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Achieving consensus on withdrawing or withholding care for critically ill patients
D K Miller1, R M Coe, T M Hyers
1Department of Internal Medicine, St. Louis Veterans Affairs Medical Center, MO 63104.
Journal of General Internal Medicine
|September 1, 1992
Summary
Understanding patient wishes is key in decisions to withhold or stop life support. These complex medical decisions involve physicians and families, balancing life extension with quality of life.
Area of Science:
- Medical Ethics
- Critical Care Medicine
- Health Communication
Background:
- Withholding or withdrawing life support is a critical decision in intensive care.
- These decisions involve complex ethical considerations regarding patient autonomy and quality of life.
Purpose of the Study:
- To examine the decision-making process for withholding or stopping life support in critically ill patients.
- To analyze the communication dynamics between physicians and families during these crucial discussions.
Main Methods:
- A survey methodology was employed in a tertiary care center's medical intensive care unit.
- Meetings between physicians and families of 15 critically ill patients were audio-recorded and transcribed.
- Analysis focused on the decision-making process, the final decision, and patient outcomes.
Main Results:
- The "patient's wishes" served as a central point for consensus negotiation, even without direct patient participation.
- Physicians typically introduced decisions directly, presented options equally, but narrowed choices towards their judgment.
- Decisions were not always aligned with the physician's initial judgment.
Conclusions:
- The process of deciding to withhold or withdraw life support is inherently complex and challenging.
- Effective management requires a deeper understanding of these processes to balance life extension, quality of life, patient autonomy, and social justice.