Allocation of critical care resources: Entitlements, responsibilities, and benefits

Graber, Glenn C.

doi:10.1016/0883-9441(93)90017-f

Cited by 3 publications

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“…Das Setzen von Grenzen fu Èr intensivmedizinisches Handeln ist unter medizinischen, ethisch-moralischen, rechtlichen und o Èko-nomisch-logistischen Gesichtspunkten unvermeidbar. Diese Grenzen ko Ènnen den angeordneten Verzicht auf Reanimationsmaûnahmen oder Therapieerweiterung, aber auch Therapie- [9]? Definition und Anwendung von Grenzen intensivmedizinischen Handelns haben in den vergangenen zehn Jahren enorm an Bedeutung gewonnen: Im Jahr 1987 war bei 51 % der Todesfa Èlle auf amerikanischen Intensivstationen eine Entscheidung u Èber Therapiebegrenzung vorangegangen, 5 Jahre spa Èter war dies bereits bei 90 % der in der Intensivstation verstorbenen Patienten der Fall [20]!…”

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Lassen sich Grenzen intensivtherapeutischen Handelns festlegen?

Schubert

Nöldge-Schomburg²

2001

Zentralbl Chir

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Medical treatment requires more than the application of techniques and devices. Knowing the limitations of (intensive) care and respecting patients' will and dignity is as important as technical skills. Limitations of therapy may arise from medical, ethical, legal, and economic reasons. Therapy may be limited through a Do-Not-Resuscitate (DNR) order, or by withholding or withdrawal of treatment. Total withdrawal of treatment ensues from proven brain death when organ donation has been denied or has been accomplished. But legislation as well as ethics and medical science fail to define unequivocal and precise criteria for limitation of treatment. Depending on the kind of disease, its prognosis and the patient's individual situation clinical scenarios can be identified when withholding or withdrawal of treatment may be thought of. The patient's expressed or anticipated wishes play a key role in decision-making on limitation of treatment. If the patient has no more decision making capacities physicians and patient's next of kin have to determine what would be in the patient's best interest. The patient and/or his family, all attending physicians and the nursing staff have to agree when limitation of care is taken into account. Hospital guidelines and written orders will help physicians and nursing staff to manage these difficult situations. Whether treatment has been limited or not, the patient and his family deserve all our medical and psychological skills--until the end.

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