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Related Experiment Videos

Foregoing life-sustaining treatment in an Israeli ICU

L A Eidelman1, D J Jakobson, R Pizov

  • 1Department of Anesthesiology and Critical Care Medicine, Hadassah University Medical Center, Hebrew University of Jerusalem, Israel.

Intensive Care Medicine
|April 16, 1998
PubMed
Summary

Physicians in Israeli intensive care units frequently withhold life-sustaining treatments, but withdrawing them is rare and reserved for brain-dead patients. Terminal patients often die within 48 hours of treatment withholding.

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Area of Science:

  • Medical Ethics
  • Intensive Care Medicine
  • Clinical Practice

Background:

  • Life-sustaining treatments (LSTs) are critical in intensive care.
  • Decisions regarding LSTs involve complex ethical and clinical considerations.
  • Practices of withholding and withdrawing LSTs vary globally.

Purpose of the Study:

  • To investigate the incidence and patterns of withholding and withdrawing LSTs in an Israeli intensive care unit (ICU).
  • To examine the timing of mortality after foregoing LSTs.
  • To understand physician practices regarding LSTs in end-of-life care.

Main Methods:

  • Prospective, descriptive study design.
  • Consecutive patient admissions to a university hospital ICU in Israel.
  • Evaluation of diagnoses, types of LSTs foregone, reasons, mortality, and time from foregoing therapy to death.

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Main Results:

  • LSTs were foregone in 13.5% of 385 patients; withholding occurred in 48 patients.
  • Withdrawing LSTs was limited to 4 brain-dead patients.
  • No antibiotics, nutrition, or fluids were withheld or withdrawn; patients died within 2.9 days of foregoing therapy.

Conclusions:

  • Withholding LSTs is common in Israeli ICUs, while withdrawing is infrequent.
  • Terminal patients die shortly after LST withholding, irrespective of withdrawal.
  • Withholding LSTs offers an alternative for those objecting to withdrawal.