Beyond Semantics: ‘Disproportionate Use of Intensive Care Resources’ or ‘Medical Futility’?

Kompanje, Erwin J. O.; Bakker, Jan

doi:10.1007/978-3-319-51908-1_40

Cited by 3 publications

(4 citation statements)

References 34 publications

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“…Sharing decisions in pediatrics constitutes a moment of global acceptance of the patient that is based on the control of pathological manifestations, attention to the human and social aspects of the disease, in the relationship with family members, in psychological and spiritual support. The effectiveness of the sharing and the good quality of the care relationship can be defined based on the clarity of the therapeutic objectives, the awareness and acceptance by the patient and the parents, the ethical sustainability and the agreed definition of the limits between intensive and palliative care ( 26 , 27 ).…”

Section: Shared Decision Makingmentioning

confidence: 99%

Information, Sharing, and Self-Determination: Understanding the Current Challenges for the Improvement of Pediatric Care Pathways

et al. 2020

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Despite the considerable progress of medical science over the years, pediatric patients can still be affected by serious illnesses that, regardless of age, lead to experiencing all the clinical, psychological, ethical and spiritual problems related to incurable diseases and death. The interaction between the peculiarities of individuals, and the clinical conditions presented define a changing and complex profile of health needs, which requires organized, dynamic and multidimensional responses. The approach to the pediatric patient must consider its biological, psychological, relational and clinical characteristics. Such aspects in fact determine and modulate the type and quantity of the needs presented, conditioning the actions to be taken and the organizational models to be implemented. In accordance with some international regulations, it is essential that healthcare professionals provide adequate information to the patient's understanding in order to enhance participation in the decision-making process regardless of the possibility of expressing consent or dissent to the treatment. Frequently, the sharing of decisions on the care path not only fails to involve children, but often lacks rigorously designed interventions for parental involvement. Therefore, the development of care models that focus on the needs of the pediatric population is crucial. The present paper aims to analyze the problems of information quality and sharing in pediatric care pathways in order to promote shared decision-making and improve the knowledge of the professionals involved. As a secondary objective, the study will provide useful insights for the prevention of decision-making conflicts frequently at the basis of the dispute in the pediatric field.

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Section: Shared Decision Makingmentioning

confidence: 99%

Information, Sharing, and Self-Determination: Understanding the Current Challenges for the Improvement of Pediatric Care Pathways

et al. 2020

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“…In our opinion such a solution should represent the basis of the daily work of medicine, regardless of specific contingencies. 13 The described patient selection and triage process identifies the role of multidisciplinary approach including palliative care. We believe that in this context palliative care must be an integral part of a multidisciplinary system built on and giving meaning to triage.…”

Section: Short Reportmentioning

confidence: 99%

COVID-19 emergency and palliative medicine: an intervention model’

Riva¹,

Caraceni

Vigorita³

et al. 2020

BMJ Support Palliat Care

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ObjectivesThe aim of this work is to describe the multidisciplinary model of intervention applied and the characteristics of some COVID-19 patients assisted by the hospital palliative care unit (UCP-H) of an Italian hospital in Lombardy, the Italian region most affected by the COVID-19 pandemic.MethodsA retrospective study was conducted on patients admitted to the A. Manzoni Hospital (Lecco, Lombardy Region, Italy) and referred to the UCP-H between 11 March 2020 and 18 April 2020, the period of maximum spread of COVID-19 in this area. Data were collected on the type of hospitalisation, triage process, modality of palliative care and psychological support provided.Results146 COVID-10 patients were referred to the UCP-H. Of these, 120 died during the observation time (82%) while 15 (10.2%) improved and were discharged from the UCP-H care. 93 had less favourable characteristics (rapid deterioration of respiratory function, old age, multiple comorbidities) and an intensive clinical approach was considered contraindicated, while 48 patients had more favourable presentations. Mean follow-up was 4.8 days. A mean of 4.3 assessments per patient were performed. As to respiratory support, 94 patients were treated with oxygen only (at different volumes) and 45 with Continuous Positive Airway Pressure (CPAP).ConclusionThe ongoing pandemic highlighted the need for dedicated palliative care teams and units for dying patients. This work highlights how palliative medicine specialist can make a fundamental contribution thanks to their ability and work experience in an organised multiprofessional context.

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“…Recommendation 1 presents the key rules in narrative form: The benchmarks, that can be identified as follows: scientific and clinical data that are as objective as possible, the best interests of the child [ 13 ], consideration of his/her pain and suffering and respect for his/her dignity [ 14 ]; Behaviour to be rejected: aggressive treatment (and the correlated ineffective and disproportionate clinical pathways), requests from parents in this sense, defensive medicine, assessments in terms of economic costs [ 15 , 16 , 17 ]. …”

Section: Global Content and Recipients Of The “Recommendations”mentioning

confidence: 99%

“…The benchmarks, that can be identified as follows: scientific and clinical data that are as objective as possible, the best interests of the child [ 13 ], consideration of his/her pain and suffering and respect for his/her dignity [ 14 ];…”

Section: Global Content and Recipients Of The “Recommendations”mentioning

confidence: 99%

The Motion of the Italian National Bioethics Committee on Aggressive Treatment towards Children with Limited Life Expectancy

et al. 2020

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The motion of the Italian National Bioethics Committee entitled “Aggressive treatment or therapeutic obstinacy on young children with limited life expectancy” comprises a premise that rejects therapeutic obstinacy and makes 12 recommendations. Recommendation no. 1 states the general rules: it ascribes a cardinal role to a shared care plan, it supports pain management therapy and pain relief, it opposes ineffective and disproportionate clinical treatment and defensive medicine. The other recommendations are correlated to the enacting of a national law establishing clinical ethics committees in paediatric hospitals; participation of parents and their fiduciaries in the decision-making processes; recourse to courts only as extrema ratio in the event of irremediable disagreement between the medical team and the family members; accompaniment at the end of life also through continuous deep sedation combined with pain therapy; access to palliative care; the need to reinforce research on pain and suffering in children; clinical trials and research studies conducted in children; the training of doctors, healthcare personnel and psychologists, to support parents in emotional and practical terms; the facilitation of the closeness of parents to children in extremely precarious clinical conditions; the relevant role of the associations of parents of sick children. Comments are made, in particular, about the innovative recommendations respectively relating to the adoption of care planning, the establishment, by law, of clinical ethics committees in paediatric hospitals and the limitation of recourse to courts—only as extrema ratio—in the event of irremediable disagreement between the medical team and the family members.

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Beyond Semantics: ‘Disproportionate Use of Intensive Care Resources’ or ‘Medical Futility’?

Cited by 3 publications

References 34 publications

Information, Sharing, and Self-Determination: Understanding the Current Challenges for the Improvement of Pediatric Care Pathways

Information, Sharing, and Self-Determination: Understanding the Current Challenges for the Improvement of Pediatric Care Pathways

COVID-19 emergency and palliative medicine: an intervention model’

The Motion of the Italian National Bioethics Committee on Aggressive Treatment towards Children with Limited Life Expectancy

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