Nav: Home

Physicians should help families with decisions about end-of-life care

June 15, 2015

MAYWOOD, IL - About 20 percent of Americans spend time in an intensive care unit around the time of their death, and most deaths follow a decision to limit life-sustaining therapies.

Physicians have a responsibility to provide recommendations to families of dying patients, a Loyola University Medical Center critical care physician writes in the journal Chest.

"A physician has a responsibility to present surrogates with the plan of care he or she believes to be in the best application of a patient's authentic values and interests to a specific clinical situation," Paul Hutchison, MD, writes.

Taking the opposite side is Robert Veatch, PhD, of Georgetown University's Kennedy Institute of Ethics. Dr. Veatch writes physicians "have no basis for recommending treatment goals and, even if they did, they would tend to distort the decision-maker's perspective."

Family members or other surrogate decision makers often have no experience in making end-of-life decisions for another person, and they struggle in this role. Making a decision without a recommendation may be overwhelming, Dr. Hutchison writes.

"When the patient's prognosis is uncertain and the treatments are potentially burdensome, surrogates often look to the physician for assistance with the treatment-limitation decisions."

After asking the surrogate about the patient's values, the physician is equipped to offer a recommendation, provided the recommendation reflects the patent's known values and not the physician's personal, political or spiritual beliefs; acknowledges the uncertainty of the prognosis; and is subject to further consideration and discussion with the surrogate. "The recommended plan is never the final word without the surrogate's assent."

Dr. Hutchison explores the physician's role in two common scenarios:

The surrogate asks the physician for a recommendation. Such a request "is an expression of his trust in the physician who has a reciprocal duty to provide guidance and support," Dr. Hutchison writes. "Failure to accept this role amounts to abandonment and requires the surrogate to bear the entire burden of the decision."

The surrogate requests aggressive therapies for a dying patient. Dr. Hutchison explains that treatments should be pursued only if they can provide benefit to the patient. "While physicians should not be individual arbiters of resource allocation at the bedside, medical resources are not infinite, and most would agree that they need to be used responsibly," Dr. Hutchison writes.

Dr. Hutchison notes we do not allow permit physicians to make end-of-life decisions without exploring a surrogate's preferences for treatments. Similarly, it would be odd for family members, who have no medical background or training, to make decisions without a physician's input.

"No matter what the content of the recommendation, however, it must always be offered with humility and with openness to contrasting perspectives," Dr. Hutchison writes. "After all, the physician and surrogate are on the same team and with the same ultimate goal: respect for the interests and dignity of the critically ill patient."
-end-
Dr. Hutchison is a specialist in pulmonary and critical care medicine. He is an assistant professor in the Department of Medicine of Loyola University Chicago Stritch School of Medicine.

Loyola University Health System

Related Intensive Care Unit Articles:

Continuous pain is often not assessed during neonatal intensive care
In an analysis of 243 neonatal intensive care units from 18 European countries, investigators found that only 2113 of 6648 (31.8 percent) newborns were assessed for prolonged, continuous pain.
Great differences in the view of withdrawing futile intensive care
The views among physicians and the general public when it comes to deciding whether to withhold or withdraw treatment of terminally ill patients differ greatly.
Primary care physician involvement at end of life associated with less costly, less intensive care
A new study published in the January/February issue of Annals of Family Medicine finds that primary care physician involvement at the end of life is associated with less costly and less intensive end-of-life care.
Public health insurance may be a predictor of pain in post anesthesia care unit
Patients using public health insurance were more likely to experience high pain levels in the post anesthesia care unit (PACU) following surgery to remove their tonsils and/or adenoids, according to a study presented at the ANESTHESIOLOGY® 2016 annual meeting.
UNC cardiologist examines training, staffing, research in cardiac intensive care
Jason Katz, M.D., M.H.S., associate professor of medicine at UNC School of Medicine and medical director of the cardiac intensive care unit, was the lead author of a recently published manuscript in the Journal of the American College of Cardiology that examined the early growth and maturation of critical care cardiology, and the challenges and uncertainties that threaten to stymie the growth of this fledgling discipline.
New hope for shock patients in intensive care
Care for critically-ill patients with shock could be improved, it is hoped, after the first successful testing by University of Oxford scientists of a new machine to record oxygen consumption in real time.
Certain red flags indicate an increased need for intensive care among patients with asthma
In patients admitted to the hospital for asthma, illicit drug use and low socioeconomic status were linked with an increased risk of requiring admission to the intensive care unit.
Quiet please in the intensive care unit!
A study presented at Euroanaesthesia 2016 shows that noise levels in the Intensive Care Unit can go well above recommended levels, disturbing both patients and the medical teams that care for them.
Physicians are more likely to use hospice and intensive care at end of life
New research suggests that US physicians are more likely to use hospice and intensive or critical care units in the last months of life than non-physicians.
Patients at high risk for psychiatric symptoms after a stay in the intensive care unit
Results of a multi-institutional national study of nearly 700 people who survived life-threatening illness with a stay in an intensive care unit suggest that a substantial majority of them are at high risk for persistent depression, anxiety and post-traumatic stress disorder -- especially if they are female, young and unemployed.

Related Intensive Care Unit Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Digital Manipulation
Technology has reshaped our lives in amazing ways. But at what cost? This hour, TED speakers reveal how what we see, read, believe — even how we vote — can be manipulated by the technology we use. Guests include journalist Carole Cadwalladr, consumer advocate Finn Myrstad, writer and marketing professor Scott Galloway, behavioral designer Nir Eyal, and computer graphics researcher Doug Roble.
Now Playing: Science for the People

#530 Why Aren't We Dead Yet?
We only notice our immune systems when they aren't working properly, or when they're under attack. How does our immune system understand what bits of us are us, and what bits are invading germs and viruses? How different are human immune systems from the immune systems of other creatures? And is the immune system so often the target of sketchy medical advice? Those questions and more, this week in our conversation with author Idan Ben-Barak about his book "Why Aren't We Dead Yet?: The Survivor’s Guide to the Immune System".