Multinational Perspectives on End-of-Life Issues in the Intensive Care Unit
Communication skills are paramount to the successful and humane practice of critical care medicine. By definition, patients admitted to the critical care unit have a substantial likelihood of dying, therefore open and honest communication with the patient and significant others must begin from the earliest moments of intensive care. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) was conducted in five large American teaching hospitals.1 This study demonstrated that physicians, patients, and families often do not communicate well concerning end-of-life issues. Further, the active intervention of a trained intermediary to enhance communication did little to improve the end-of-life experience, and many patients who would have otherwise wished to forgo resuscitation spent time comatose or mechanically ventilated prior to death.
KeywordsIntensive Care Unit Palliative Care Gross Domestic Product Intensive Care Unit Admission Life Support
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- 9.Ross, E. On death and dying. New York: Macmillian; 1970.Google Scholar
- 10.Madore O. The Canada Health Act: overview and options (94-4E). Library of Parliament Parliamentary Information and Research Service. Available at: http://www.parl.gc.ca/information/library/PRBpubs/944-3.htm.Accessed October 4, 2005.
- 11.Jackman M. The application of the Canadian Charter in the health care context. Health Law Rev 2001;9(2):22–27. Available at: http://www.law.ualberta.ca/centres/hli/pdfs/hlr/v9_2/jackmanfrm.pdf. Accessed October 4, 2005.Google Scholar
- 13.Scardoni v. Hawryluck. CanLII 34326 (ON S.C.). 2004. Available at: http://www.canlii.org/on/cas/onsc/2004/2004onsc10339.html. Accessed October 4, 2005.
- 17.Te Ara – the encyclopaedia of New Zealand. Ministry for Culture and Heritage. New Zealand Government. Available at: http://www.teara.govt.nz/en.
- 18.Global corruption report 2005. Transparency International. Berlin, Germany. Available at: http://www.globalcorruptionreport.org/download.html.
- 19.The World Factbook 2005. Washington, DC: Central Intelligence Agency. Office of Public Affairs. Available at: http://www.cia.gov/cia/publications/factbook/.
- 20.New Zealand Health Expenditures 2002. World Health Organization. Available at: http://www.who.int/countries/nzl/en/.
- 23.Phillips GD, Trubuhovich RV. A record of events–the first 25 years. Carlton: Australian and New Zealand Intensive Care Society; 2001. Available at: http://www.anzics.com.au/files/history_first_25.pdf.
- 24.Higlett T, Bishop N, Hart GK, Hicks P. Review of intensive care resources and activity 2002/2003. Melbourne: Australian and New Zealand Intensive Care Society; 2005. Available at: http://www.anzics.com.au/admc/files/arcccr_03report.pdf.
- 27.Minimum standards for intensive care units. Joint Faculty of Intensive Care Medicine, Australian and New Zealand College of Anaesthetists and Royal Australasian College of Physicians. 2003. Available at: http://www.jficm.anzca.edu.au/pdfdocs/ic1_2003.pdf.
- 28.Statement on the ethical practice of intensive care medicine. Joint Faculty of Intensive Care Medicine, Australian and New Zealand College of Anesthetists and Royal Australasian College of Physicians. 2002. Available at: http://www.jficm.anzca.edu.au/pdfdocs/ic9_2002.pdf.
- 29.Statement on withholding and withdrawing treatment. Joint Faculty of Intensive Care Medicine, Australian and New Zealand College of Anesthetists and Royal Australasian College of Physicians. 2004. Available at: http://www.jficm.anzca.edu.au/publications/policy/ic14_2004.htm.
- 30.The Health and Disability Commissioner Act 1994. Available at: http://www.hdc.org.nz/index.php.
- 33.Cassell J. Life and death in intensive care. Philadelphia: Temple University Press; 2005.Google Scholar
- 34.Streat S. When do we stop? Crit Care Resuscitation 2005;7:227–232.Google Scholar
- 41.Paulo Medical Council. Public consultation on the patient’s will to refuse extraordinary support measures to prolong life. Available at: http://www.bioetica.org.br/legislacao/res_par/integra/29535_03.php.
- 42.Paulo Medical Council. Public consultation on cases when the physician can refuse invasive support measures and ICU admission for elderly patients. Available at: http://www.bioetica.org.br/legislacao/res_par/integra/15744_01.php.
- 43.Palliative care and end of life policies in Colombia. Available at: http://www.eolc-observatory.net/global_analysis/colombia_reading.htm.
- 44.ACP-ASIM End-of-Life Care Patient Education Project. Available at: http://www.acponline.org/ethics/patient_education.htm and http://www.acponline.org/chapters/latin/br/nov2001.htm.
- 45.Vidalis A, Dardavessis T, Kaprinis G. Euthanasia in Greece: moral and ethical dilemmas. Aging (Milano) 1998;10:93–101.Google Scholar
- 51.Bhagwanjee S. Audit of intensive care utilisation in KwaZulu Natal: focus on King Edward VIII and Addington Hospitals. Paper presented to KZN Healthcare Task Team. 1998.Google Scholar
- 52.Lyons RA, Wareham K, Hutchings HA, Major E, Ferguson B. Population requirement for adult critical care beds: a prospective quantitative and qualitative study. Lancet 2000;355.Google Scholar
- 53.Burrows RC, Gopalan PD, Hodgson RE. DNR–The importance of the medical decision. World Congress of Intensive Care. Sydney, Australia. 2001. Free Paper 31.Google Scholar
- 57.Thiagraj Soobramoney vs. Minister of Health, Province of Kwazulu-Natal, South Africa. Durban Supreme Court Case Number 5846197, August 1997.Google Scholar
- 58.Manara AR, Pittman JA, Braddon FE. Reasons for withdrawing treatment in patients receiving intensive care.Anaesthesiology 1998;53:523–528.Google Scholar