Seeking Worldwide Professional Consensus on the Principles of End-of-Life Care for the Critically Ill. The Consensus for Worldwide End-of-Life Practice for Patients in Intensive Care Units (WELPICUS) Study

Abstract

Great differences in end-of-life practices in treating the critically ill around the world warrant agreement regarding the major ethical principles. This analysis determines the extent of worldwide consensus for end-of-life practices, delineates where there is and is not consensus, and analyzes reasons for lack of consensus. Critical care societies worldwide were invited to participate. Country coordinators were identified and draft statements were developed for major end-of-life issues and translated into six languages. Multidisciplinary responses using a web-based survey assessed agreement or disagreement with definitions and statements linked to anonymous demographic information. Consensus was prospectively defined as >80% agreement. Definitions and statements not obtaining consensus were revised based on comments of respondents, and then translated and redistributed. Of the initial 1,283 responses from 32 countries, consensus was found for 66 (81%) of the 81 definitions and statements; 26 (32%) had >90% agreement. With 83 additional responses to the original questionnaire (1,366 total) and 604 responses to the revised statements, consensus could be obtained for another 11 of the 15 statements. Consensus was obtained for informed consent, withholding and withdrawing life-sustaining treatment, legal requirements, intensive care unit therapies, cardiopulmonary resuscitation, shared decision making, medical and nursing consensus, brain death, and palliative care. Consensus was obtained for 77 of 81 (95%) statements. Worldwide consensus could be developed for the majority of definitions and statements about end-of-life practices. Statements achieving consensus provide standards of practice for end-of-life care; statements without consensus identify important areas for future research.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

“…Despite differences in geographic location, legal system, religion, and culture, there is worldwide professional consensus for key end-of-life practices in the ICU [651].…”

Non-Faith-Based Arguments against Physician-Assisted Suicide and Euthanasia

“…In fact, in one Belgian statement, the authors endorsed using medications to end patients' lives even in the absence of suffering (Vincent et al 2014, n. 6), a practice that was found offensive and actively rebutted by a group of Dutch physicians (Kompanje et al 2014). Such SDP is a practice that was reported by 2 percent of physicians in seven European countries (Sprung et al 2003), but which is Embracing excellent palliative care is the correct answer Physician integrity and patient trust PAS undermines the integrity of both physician and patient as it is a contradiction to the patient's seeking to be well; and a violation of the principled duty of the physician to help the patient to become well Undermined physician integrity is leading to loss of patient trust in physicians felt by 79 percent of physicians to be wrong and intolerable even if allowed by law (Sprung et al 2014). With such active conversations occurring, especially now that the Canadian Supreme Court has recently ruled in favor of physician-assisted suicide, it is more important than ever to be adept with defense of life arguments, which are also arguments in defense of the healing profession of medicine at large.…”

Addressing uncertainty: what is the role of consensus in end-of-life care?

“…Without high-quality evidence to guide decision-making, the importance of consensus in end-of-life care becomes readily apparent. Although it may be impractical to establish a universal understanding of what is "beneficial" or what it means to "do no harm" at the end of life, achievement of consensus is possible in many different areas of end-of-life care [1]. When driven by a desire to improve the quality of dying and death for patients and their family members, consensus in end-of-life care can serve as an important source of direction for clinicians.…”

“…Efforts to achieve consensus will reveal areas of agreement and disagreement, and both can be informative. Achieving and formulating consensus can establish a standard of practice for end-of-life care, while a lack of consensus may highlight areas ripe for future research [1]. Of course, recommendations made from consensus based on low-quality evidence or expert opinion are unlikely to be universally accepted, and disagreement with such recommendations should be respected.…”