Limitation of life support: Frequency and practice in a Hong Kong intensive care unit*

Buckley, Thomas; Joynt, Gavin M.; Tan, Perpetua E.; Cheng, Claudia; Yap, Florence

doi:10.1097/01.ccm.0000110675.34569.a9

Cited by 49 publications

(40 citation statements)

References 38 publications

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“…Previous medical studies have highlighted some subtle cultural differences between Hong Kong and the Western countries. 21,[30][31][32] In Chinese society there is less emphasis on individual rights, selfexpression and self-determination and more emphasis on community qualities such as harmony, function, and responsibility. Thus health care decisions within Chinese culture may be more family centered, with decisions made by the family as a group rather than the individual.…”

Section: Discussionmentioning

confidence: 99%

Changes in Medical Students’ Attitudes Towards End-of-Life Decisions Across Different Years of Medical Training

Gruber¹,

Gomersall²,

Joynt³

et al. 2008

J GEN INTERN MED

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BACKGROUND: Decisions to forgo life-sustaining medical treatments in terminally ill patients are challenging, but ones that all doctors must face. Few studies have evaluated the impact of medical training on medical students' attitudes towards end-of-life decisions and none have compared them with an age-matched group of non-medical students. OBJECTIVE:To assess the effect of medical education on medical students' attitudes towards end-of-life decisions in acutely ill patients. DESIGN:Cross-sectional study.PARTICIPANTS: Four hundred and two students at The Chinese University of Hong Kong. MEASUREMENTS:Completion of a questionnaire focused on end-of-life decisions. MAIN RESULTS:The number of students who felt that cardiopulmonary resuscitation must always be provided was higher in non-medical students (76/90 (84%)) and medical students with less training (67/84 (80%) in year 1 vs. 18/67 (27%) in year 5) (p<0.001). Discontinuing life-support therapy was more accepted among senior medical students compared to junior medical and non-medical students (27/66 (41%) in year 5 vs. 18/83 (22%) in year 1 and 20/90 (22%) in non-medical students) (p=0.003). An unexpectedly large proportion of non-medical students (57/89 (64%)) and year 1 medical students (42/84 (50%)) found it acceptable to administer fatal doses of drugs to patients with limited prognosis. Euthanasia was less accepted with more years of training (p<0.001). When making decisions regarding limitation of life-support therapy, students chose to involve patients (98%), doctors (92%) and families (73%) but few chose to involve nurses (38%). CONCLUSIONS:Medical students' attitudes towards end-of-life decisions changed during medical training and differed significantly from those of non-medical students.

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Section: Discussionmentioning

confidence: 99%

Changes in Medical Students’ Attitudes Towards End-of-Life Decisions Across Different Years of Medical Training

Gruber¹,

Gomersall²,

Joynt³

et al. 2008

J GEN INTERN MED

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“…While Western ICU doctors' reported behaviour and attitudes have been established by several surveys and observational studies [3][4][5][6][7][8][9][10][11][12][13][14], relatively little is known of Chinese ethical attitudes outside Hong Kong [15][16][17]. Although culturally Chinese, Hong Kong has a unique colonial history and the ethical attitudes and behaviour of ICU doctors in China may be quite different from those of Western or Hong Kong ICU doctors.…”

Section: Introductionmentioning

confidence: 99%

Attitudes towards ethical problems in critical care medicine: the Chinese perspective

et al. 2011

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“…Most of these deaths occur after decisions are made to limit life support (2,3), and these decisions are often made by surrogate decision makers because patients' decision-making capacity is impaired (4,5). Although the extent of surrogate involvement in end-of-life decision making varies among different cultures and countries (6)(7)(8)(9)(10), US law dictates that patients who lose decision-making capacity retain the right to control their future medical treatments, including decisions about withdrawal of life support, by transfer of decision-making authority to surrogate decision makers (11). Thus, US surrogate decision makers have considerable authority in end-of-life decision making and, for instance, may decline life-prolonging treatments or refuse withdrawal of life support for incapacitated patients despite physician recommendations.…”

mentioning

confidence: 99%

Recommendations to Limit Life Support

Brush

Rasinski

Hall

et al. 2012

Am J Respir Crit Care Med

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Rationale: There is debate about whether physicians should routinely provide patient surrogates with recommendations about limiting life support. Objectives: To explore physicians' self-reported practices and attitudes. Methods: A cross-sectional, stratified survey of 1,000 randomly selected US critical care physicians was mailed. We included a vignette to experimentally examine how surrogate desire for a recommendation and physician agreement with the surrogate modified whether physicians would provide a recommendation. Measurements and Main Results: Proportion of respondents reporting they routinely provide surrogates with a recommendation and how responses varied based on vignette characteristics. A total of 608 (66%) of 922 eligible physicians participated. Approximately one (22%) in five reported always providing surrogates with a recommendation, whereas 1 (11%) in 10 reported rarely or never doing so. Almost all respondents reported comfort making recommendations (92%) and viewed them as appropriate (93%). Most also viewed recommendations as a critical care physician's duty (87%) and did not view them as unduly influential (80%). Approximately two-fifths (41%) believed recommendations were only appropriate if sought by surrogates. In response to the vignettes, nearly all respondents (91%) provided a recommendation when the surrogate requested a recommendation and the physician agreed with the surrogate's likely decision. Physicians were less likely to provide an unwanted recommendation, both when physicians agreed (29%) and disagreed with the surrogate's likely decision (44%). Conclusions: There is substantial variation among physicians' selfreported use of recommendations to surrogates of critically ill adults. Surrogates' desires for recommendations and physicians' agreement with surrogates' likely decisions may have important influence on whether recommendations are provided.

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Limitation of life support: Frequency and practice in a Hong Kong intensive care unit*

Cited by 49 publications

References 38 publications

Changes in Medical Students’ Attitudes Towards End-of-Life Decisions Across Different Years of Medical Training

Changes in Medical Students’ Attitudes Towards End-of-Life Decisions Across Different Years of Medical Training

Attitudes towards ethical problems in critical care medicine: the Chinese perspective

Recommendations to Limit Life Support

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