International Differences in End-of-Life Attitudes in the Intensive Care Unit

Yaguchi, Arino; Truog, Robert D.; Curtis, J. Randall; Luce, John M.; Levy, Mitchell M.; Mélot, Christian; Vincent, Jean‐Louis

doi:10.1001/archinte.165.17.1970

Cited by 190 publications

(147 citation statements)

References 29 publications

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“…(29) Probably due to this shortcoming in the legislation and to cultural issues, Brazilian physicians prefer to give verbal and informal orders not to resuscitate. (30) However, Deheinzelin (18) states that the verbal do-not-resuscitate order may conflict with Bioethical principles, regarding the patient's autonomy. These principles define that every human being has the right to be informed about the therapeutic modes available for his clinical situation and about the prognosis of his disease.…”

Section: Discussionmentioning

confidence: 99%

Avaliação das decisões médicas durante o processo do morrer

Moritz¹,

Machado²,

Heerdt³

et al. 2009

Rev. bras. ter. intensiva

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Section: Discussionmentioning

confidence: 99%

Avaliação das decisões médicas durante o processo do morrer

Moritz¹,

Machado²,

Heerdt³

et al. 2009

Rev. bras. ter. intensiva

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“…Several different studies [14][15][16][17][18][19] have demonstrated marked differences not just between different regions on the planet, but also within each country, even in the same city. 20,21 These differences exist in all phases of the LSL decision: from the initial process to its conclusions, ending with the withdrawal or withholding of life support treatment.…”

Section: Differences Between Countriesmentioning

confidence: 99%

“…The interval between decision and action taken is 30 minutes, which is much lower than interval described in European countries, which is 2 days. 17,18,20 The reason for this may be the way in which the decision is taken. In the USA, when a decision is taken to suspend treatment, the doctors immediately take this action in the presence of the family.…”

Section: Differences Between Countriesmentioning

confidence: 99%

Cuidados de final de vida em crianças: perspectivas no Brasil e no mundo

Lago¹,

Devictor²,

Piva³

et al. 2007

J. Pediatr. (Rio J.)

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Objective: To analyze the medical practices and the end-of-life care provided to children admitted to pediatric intensive care units in different parts of the globe. Sources:Articles on end-of-life care published during the last 20 years were selected from the PubMed, MEDLINE and LILACS databases, with emphasis on studies of death in pediatric intensive care units in Brazil, Latin America, Europe and North America, using the following keywords: death, bioethics, pediatric intensive care, cardiopulmonary resuscitation and life support limitation. Summary of the findings: Publications on life support limitation (LSL) are concentrated in North America andEurope. In North American pediatric intensive care units there is a greater incidence of LSL (~60%) than in Europe or Latin America (30-40%). These differences appear to be related to cultural, religious, legal and economic factors. Over the last decade, LSL in Brazilian pediatric intensive care units has increased from 6 to 40%, with do not resuscitate orders as the most common method. Also of note is the low level of family participation in the decision-making process.A recent resolution adopted by the Federal Medical Council (Conselho Federal de Medicina) regulated LSL in our country, demystifying a certain apprehension of a legal nature. The authors present a proposal for a protocol to be followed in these cases. Conclusions:The adoption of LSL with children in the final phases of irreversible diseases has ethical, moral and legal support. In Brazil, these measures are still being adopted in a timid manner, demanding a change in behavior, especially in the involvement of families in the decision-making process.J Pediatr (Rio J). 2007;83(2 Suppl):S109-116. Death, limitation of life support, pediatric intensive care, medical ethics.

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“…Health care policies, available resources, and societal consensus on the management approach would also impact on the clinical decisions of withdrawing or withholding treatment for severely sick patients [8,21–24]. We therefore undertook this survey to explore the renal physicians’ practices of withholding and withdrawal of dialysis treatment during provision of renal care at end-of-life for patients with ESKD in UAE.…”

Section: Introductionmentioning

confidence: 99%

Provision of renal care for patients with end stage kidney disease in persistent vegetative state, in United Arab Emirates: a national survey of renal physicians

Alshamsi

Chaaban

Alrukhaimi

et al. 2018

Libyan Journal of Medicine

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Patients with end stage kidney disease (ESKD) with severely impaired cognitive function have no survival benefit from dialysis. We therefore undertook a survey to explore the renal physicians’ practices of withholding and withdrawal of dialysis treatment in vegetative state patients in the United Arab Emirates (UAE). A cross sectional survey of 29 nephrology practices in UAE exploring physicians’ practices in making decisions of withholding and withdrawal of dialysis treatment during provision end-of-life care for patients in persistent vegetative state (PVS).The majority of participants practice in governmental non-for-profit dialysis units (79%), and think they are well prepared to make decision with patients and family on issues of dialysis withdrawal and withholding (69%). If a chronic dialysis patient became permanently unconscious only few respondents (17%) indicated probability of stopping dialysis. On the other hand, more respondents (48%) reported that dialysis is likely to be withheld in PVS patients who develop kidney failure. In high risk or poor prognosis ESKD patients and given how likely they would consider each option independently, respondents reported they are likely to consider time-limited dialysis in 78% of the time followed by stopping (46%) or forgoing (27%) dialysis. Majority of the participants perceived that their decisions in providing renal care for PVS patients in UAE were influenced by the family sociocultural beliefs (76% of participants), the current hospital policies (72% of participants), and by Islamic beliefs (66% of participants). Only few perceived access to palliative care (30%) and treatment cost (17%) to have an impact on their decision making.Decisions of initiation and continuation of dialysis treatment to ESKD patients in PVS are prevalent among nephrology practices in UAE. Development of local guidelines based on the societal values along with early integration of palliative kidney failure management care would be required to improve the quality of provision of end-of-life renal care in UAE.Abbreviations: ESKD: stage kidney disease; UAE: United Arab Emirates; PVS: persistent vegetative state; RPA: Renal Physicians Association; ASN: American Society of Nephrology; EMAN: Emirates Medical Association Nephrology Society; CPR: cardiopulmonary resuscitation.

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International Differences in End-of-Life Attitudes in the Intensive Care Unit

Abstract: In countries where intensive care medicine is relatively well developed, considerable differences remain in physicians' attitudes toward end-of-life care in the intensive care unit. Substantial work remains if an international consensus on these issues is to be reached.

Cited by 190 publications

References 29 publications

Avaliação das decisões médicas durante o processo do morrer

Avaliação das decisões médicas durante o processo do morrer

Cuidados de final de vida em crianças: perspectivas no Brasil e no mundo

Provision of renal care for patients with end stage kidney disease in persistent vegetative state, in United Arab Emirates: a national survey of renal physicians

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