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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.
Objective:
To determine whether physicians in Israel withhold and/or withdraw life-sustaining treatments.
Design:
A prospective, descriptive study of consecutively admitted patients. Patients were prospectively evaluated for diagnoses, types and reasons for foregoing life-sustaining treatment, mortality and times from foregoing therapy until mortality.
Setting:
A general intensive care unit of a university hospital in Israel.
Results:
Foregoing life-sustaining treatment occurred in 52 (13.5%) of 385 patients admitted and 5 (1%) had cardiopulmonary resuscitation. Withholding therapy occurred in 48 patients. Four patients with brain death had all treatments withdrawn. No patient had antibiotics, nutrition or fluids withheld or withdrawn. Time from foregoing therapy until death was 2.9 +/- 0.6 days. Thirty-one of 48 (65%) patients who had therapy withheld died within 48 h.
Conclusions:
Withholding life-prolonging treatments is common in an Israeli intensive care unit whereas withdrawing therapy is limited to brain dead patients. Terminal patients die soon after withholding, even if the therapy is not withdrawn. Withholding treatments should be an option for patients and professionals who object to withdrawing therapies.