End-of-life decisions in an Indian intensive care unit

Mani, Raj; Mandal, Amit Kumar; Bal, Sabyasachi; Javeri, Yash; Kumar, Rakesh; Nama, Deepak Kumar; Pandey, Praveen; Rawat, Tara; Singh, Navneet; Tewari, Hemant; Uttam, Rajiv

doi:10.1007/s00134-009-1561-x

Cited by 52 publications

(50 citation statements)

References 36 publications

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“…Classically, the therapies most acknowledged as futile or useless are vasoactive drugs and dialysis methods. (14,15,(17)(18)(19)(20)(21)(22)(23) In the last years, the acceptance of withdrawing mechanic ventilation as a palliative ICU measures is growing. (9,24) Also is currently discussed the relevance of appropriate intensive care professionals' training in end-of-life patients management competencies.…”

Section: Discussionmentioning

confidence: 99%

Percepção dos profissionais sobre o tratamento no fim da vida, nas unidades de terapia intensiva da Argentina, Brasil e Uruguai

Moritz

Deicas

Rossini³

et al. 2010

Rev. bras. ter. intensiva

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Objective: To evaluate end-of-life procedures in intensive care units.Methods: A questionnaire was prepared by the End-of-Life Study Group of the Argentinean, Brazilian and Uruguayan Intensive Care societies, collecting data on the participants' demographics, institutions and limit therapeutic effort (LTE) decision making process. During this cross sectional study, the societies' multidisciplinary teams members completed the questionnaire either during scientific meetings or online. The variables were analyzed with the Chi-square test, with a p<0.05 significance level.Results: 420 professionals completed the questionnaire. The Brazilian units had more beds, unrestricted visit was less frequent, their professionals were younger and worked more recently in intensive care units, and more non-medical professionals completed the questionnaire. Three visits daily was the more usual number of visits for the three countries. The most influencing LTE factors were prognosis, co-morbidities, and therapeutic futility. In the three countries, more than 90% of the completers had already made LTE decisions. Cardiopulmonary resuscitation, vasoactive drugs administration, dialysis and parenteral nutrition were the most suspended/refused therapies in the three countries. Suspension of mechanic ventilation was more frequent in Argentina, followed by Uruguay. Sedation and analgesia were the less suspended therapies in the three countries. Legal definement and ethical issues were mentioned as the main barriers for the LTE decision making process.Conclusion: LTE decisions are frequent among the professionals working in the three countries' intensive care units. We found a more proactive LTE decision making trend In Argentina, and more equity for decisions distribution in Uruguay. This difference appears to be related to the participants' different ages, experiences, professional types and genders.

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Section: Discussionmentioning

confidence: 99%

Percepção dos profissionais sobre o tratamento no fim da vida, nas unidades de terapia intensiva da Argentina, Brasil e Uruguai

Moritz

Deicas

Rossini³

et al. 2010

Rev. bras. ter. intensiva

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show abstract

“…However, the treating doctor has an obligation to ameliorate the patient's financial concerns by all means possible, including waiving of fees and involving other members of the health care team to help resolve the perceived problem. 11,20 When the patient is incompetent and NOK expresses financial concerns, the physician's obligation becomes to ensure that there is no conflict of interest between NOK's economic concerns and patient's benefit before withdrawing support.…”

Section: Withholding or Withdrawalmentioning

confidence: 99%

“…Intent will become a material consideration in such a case. 1,3,20 The distinction between suicide and euthanasia has been elucidated in the case of Naresh Marotrao Sakhre vs. Union of India (1994) where it has been held that, "Euthanasia or mercy killing is nothing but homicide whatever the circumstances in which it is effected. "…”

Section: Legal Aspects Of End Of Life Issues In Indiamentioning

confidence: 99%

End of Life Issues in the Intensive Care Units

Datta

Chaturvedi²,

Rudra

et al. 2013

Medical Journal Armed Forces India

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“…Despite these barriers, a recent study from Delhi had reported that 49% deaths were preceded by EOL decisions. 5 The EIU, besides condemning India for poor palliative care system, also highlights Kerala as a successful model for the rest of world to follow. Kerala takes a uniquely community driven, holistic approach to EOL care.…”

Section: End Of Life Decision In Indian Armed Forces Hospitals Introdmentioning

confidence: 99%

End of life decision in Indian Armed Forces hospitals

Singhal¹,

Banerji²

2012

Medical Journal Armed Forces India

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End-of-life decisions in an Indian intensive care unit

Abstract: Despite societal and legal barriers, half the patients dying in the ICU received a decision to limit therapy mostly as withholding or DNR orders. These decisions evolved early in the course of stay and resulted in significant reduction of therapeutic burdens.

Cited by 52 publications

References 36 publications

Percepção dos profissionais sobre o tratamento no fim da vida, nas unidades de terapia intensiva da Argentina, Brasil e Uruguai

Percepção dos profissionais sobre o tratamento no fim da vida, nas unidades de terapia intensiva da Argentina, Brasil e Uruguai

End of Life Issues in the Intensive Care Units

End of life decision in Indian Armed Forces hospitals

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