Withholding and withdrawal of life support from the critically ill

Article Abstract:

The circumstances and decision processes which surrounds the medical decision to withhold or withdrawal life support from terminally ill patients in a major teaching hospital are explored. During a one-year period, 1,719 patients were admitted to two affiliated hospitals; life support was withheld from 22 patients (one percent) and withdrawn from 93 patients (five percent). Two days was the average hospitalization of patients who died following the withholding or withdrawal of life support. All but one of the patients died shortly after the decision was made. Approximately 45 percent of these patients died while still in the emergency room. The decision-making process usually begins during hospital rounds of the patients by their primary care physicians and intensive care teams. Five patients of the total group were competent and participated in the decision to discontinue support or elected not to authorize further medical procedures. However, the majority of the patients (110 of the 115) were judged incompetent, and medical decisions were made by family members (102 cases) or their physicians (eight patients). Once a decision was reached, "do-not-resuscitate" orders were written in 93 percent of cases. The presence of brain death was given as the sole reason for these medical orders for 18 patients. Other reasons for the decision to withhold or withdraw life support included a poor prognosis (97 patients), futility of continued support, and extreme suffering. By far, most patients for whom such action is taken are already judged incompetent by their physicians; the decision is usually made by family members. The effects of heroic efforts to save the unsalvageable patient and the contribution of these efforts to rising medical costs are also discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Case studies, Terminally ill persons, Terminally ill, Physician and patient, Physician-patient relations, Terminal care, Ethical aspects

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Ordering and administration of sedatives and analgesics during the withholding and withdrawal of life support from critically ill patients

Article Abstract:

A study of 44 critically-ill patients in intensive care units who had been taken off life support found that 33 (75%) were given sedatives and analgesics (pain-killers) to treat pain and anxiety and to comfort family members. While 36% were given these drugs to hasten their death, this was never the only reason given by the health care team. The patients who received the drugs died an average of 3.5 hours after life support was discontinued, and the patients who did not receive medication died an average of 1.3 hours after life support was discontinued. It may appear that the drugs prolonged the lives of these patients, but in fact, patients who were not given drugs were more likely to be comatose, and these patients would be more likely to die following the removal of life support. Members of the health care team justified the use of these drugs on the grounds that the patient should be spared any pain and suffering once the family has decided to withdraw life support.

Care and treatment, Planning, Dosage and administration, Sedatives, Hypnotics and sedatives, Critically ill, Analgesics

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Persons found in their homes helpless or dead

Article Abstract:

Elderly people living alone have a substantial risk of becoming incapacitated for hours with no one to help them. Emergency medical personnel in San Francisco found 367 people in a 12-week period who lived alone and were found incapacitated or dead. Almost one-fourth were found dead and 5% died in the hospital. Sixty-two percent of those alive were hospitalized and half needed intensive care. Sixty-two percent could no longer function independently upon discharge and had to be transferred to an institution, usually a nursing home.

Health aspects, Aged, Elderly, Home accidents

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