Thursday, July 9, 2009

End-of-Life Decision Making - A Summary and Primer

In the March 2009 issue of Clinics in Chest Medicine, Yale MICU Director Mark Siegel has a very thorough review (with 151 footnotes) of end-of-life decision making in the ICU.
Siegel covers rationing & triage, futility, advance directives, and surrogates. But the bulk of the article is devoted to practical advice on good communication, discussing prognosis, and successful family meetings. Here is the abstract:
A large proportion of deaths, particularly in the developed world, follows admission to an ICU. Therefore, end-of life decision making is an essential facet of critical care practice. For intensivists, managing death in the critically ill has become a key professional skill. They must be thoroughly familiar with the ethical framework that guides end-of-life decision making. Decisions should generally be made collaboratively by clinicians partnering with patients' families. Treatment choices should be crafted to meet specific, achievable goals. A rational, empathic approach to working with families should encourage appropriate, mutually satisfactory outcomes.

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