Medical decisions concerning the end of life: a discussion with Japanese physicians.

Asai, Atsushi; Fukuhara, Shunichi; Inoshita, Osamu; Miura, Yuri; Tanabe, Noboru; Kurokawa, Kiyoshi

doi:10.1136/jme.23.5.323

Cited by 52 publications

(45 citation statements)

References 3 publications

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“…Possivelmente, a falta de políticas para a adoção de limites terapêuticos em pacientes com pouca ou nenhuma esperança de vida, mesmo num contexto de escassez de recursos, poderia explicar essa grande diferença. Despreparo da equipe para discutir entre si e com a família sobre limites terapêuticos, ou uma relação de confiança entre a equipe e a família ainda não bem estabelecida, ou dificuldades culturais e religiosas na elaboração e aceitação dos limites terapêuticos e da morte 1,6,9,28,29 poderiam ser outros motivos para justificar períodos de internação tão prolongados na UTI até a ocorrência do óbito.…”

Section: D D D Discussão Iscussão Iscussão Iscussão Iscussãounclassified

Modos de morrer na UTI pediátrica de um hospital terciário

Carvalho¹,

Rocha²,

Espírito-Santo³

et al. 2001

Rev. Assoc. Med. Bras.

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Section: D D D Discussão Iscussão Iscussão Iscussão Iscussãounclassified

Modos de morrer na UTI pediátrica de um hospital terciário

Carvalho¹,

Rocha²,

Espírito-Santo³

et al. 2001

Rev. Assoc. Med. Bras.

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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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“…If dying should be "patient-focused and family-centered" (Teno, Byock, & Field, 1999), then it is critical to understand the experience and the effects of intervention from this perspective. I found it somewhat surprising that there are fewer qualitative studies of patients and families than there are of clinicians (Asai et al, 1997;Calam, Far, & Andrew, 2000;Ekblad, Marttila, & Emilsson, 2000;Fetters, Churchill, & Danis, 2001;Matzo & Schwarz, 2001;Oberle & Hughes, 2001).…”

Section: Methodsmentioning

confidence: 99%