Withholding and withdrawing life-support therapy in an Emergency Department: prospective survey

Conte, Philippe Le; Baron, D.; Trewick, David; Touze, Marie-Dominique; Longo, Carlos Alberto; Vial, Irshaad; Yatim, D.; Potel, G

doi:10.1007/s00134-004-2475-2

Cited by 70 publications

(66 citation statements)

References 11 publications

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“…De nombreuses données restent à établir sur l'évaluation de la prise en charge de ces patients cancéreux aux urgences et pourraient faire l'objet d'un autre travail. Des études et des programmes de recherche sont en cours pour optimiser la prise en charge des patients palliatifs aux urgences, avec notamment à Nantes la réalisation d'une fiche de limitation ou d'arrêt des soins actifs [10]. Le peu de publications sur le sujet et les questions suscitées par ce travail montrent l'intérêt d'une telle problématique et d'une analyse de ce type de population que l'on ne devrait moins voir aux urgences.…”

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Une meilleure organisation des soins pourrait diminuer le nombre des patients atteints de cancer adressés aux urgences

et al. 2007

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Section: Figureunclassified

Une meilleure organisation des soins pourrait diminuer le nombre des patients atteints de cancer adressés aux urgences

et al. 2007

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“…La plus récente, intitulée SU-DALISA [3], a exploré la population des patients décédés dans les services d'urgence et a plus particulièrement investigué les décisions de Lata. Un autre travail monocentrique et prospectif a spécifiquement exploré les décisions de Lata dans un service d'urgence [4]. Enfin, un article de synthèse a été consacré à la fin de vie aux urgences dans cette même revue [5].…”

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Décisions de limitation ou d’arrêt des thérapeutiques actives dans les services d’urgence

et al. 2008

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“…Indeed, withdrawing ventilation, discontinuing fluid resuscitation, or turning off a pacemaker can be more valid from an ethical perspective than hesitating in a true emergency when the person's situation is unclear and delay will lead to death. [17][18][19] It is important, however, in the case of a known hospice patient, not to invoke the ''emergency exception'' to initiate resuscitative procedures. ''Do no harm'' requires support in the dying process when patient wishes are clear.…”

Section: Ethical Considerationsmentioning

confidence: 99%

Ethics Seminar: The Hospice Patient in the ED: An Ethical Approach to Understanding Barriers and Improving Care

Zieske

Abbott²

2011

Academic Emergency Medicine

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Emergency physicians (EPs) are asked to evaluate and treat a growing population of hospice patients who present to the emergency department (ED) for a number of important reasons. Hospice patients pose unique ethical challenges, and ''best practices'' for these patients can differ from the life-preserving interventions of usual ED care. Having a solid understanding of professional responsibilities and ethical principles is useful for guiding EP management of these patients. In end-of-life care, EPs need to recognize that there are barriers and complexities to the best management of hospice patients, but they need to commit to strategies that optimize their care.This article describes the case of a hospice patient who presented with sepsis and end-stage cancer to the ED. Patient, system, and physician factors made management decisions in the ED difficult. The goal in the ED should be to determine the best way to address terminally ill patient needs while respecting wishes to limit interventions that will only increase suffering near the end of life.ACADEMIC EMERGENCY MEDICINE 2011; 18:1201-1207 ª 2011 by the Society for Academic Emergency Medicine M edical management of hospice patients requires nuanced diagnostic and treatment decisions that are less straightforward than typical emergency department (ED) care. The best approach to each hospice patient is achieved when emergency physicians (EPs) understand the ethical principles on which their professional responsibilities are based. We present the case of a hospice patient who arrived in extremis to the ED and review the ethical principles surrounding hospice care. We also highlight the barriers that occurred with this patient and barriers that are often seen in other ED hospice situations. Principles and practical steps are recommended to help guide EPs toward achieving the best care for hospice patients in the rapid tempo of the ED. CASE VIGNETTEHM was a 35-year-old Vietnamese male with metastatic lung cancer brought to the ED by ambulance during a busy overnight shift. His chief concern was ''chest, abdominal, and flank pain.'' This patient was well known to the staff and had presented to our ED with similar complaints three times over the prior 3 weeks. His cancer was advanced, with brain, liver, pancreas, and bone metastases. His medical record indicated that he had failed an aggressive chemotherapy regimen and had undergone whole brain radiation and gamma knife therapy since his diagnosis 18 months before the current presentation.The patient had been enrolled in a hospice program approximately 1 week prior to this visit through an oncologist at another hospital. He had visited the ED most recently 2 days earlier and was noted to be in pain, tachycardic, and febrile. A chest radiograph, urinalysis, blood, and urine cultures were obtained, but the judgment of the ED staff at that time was that admission for further workup of his fever was not in line with his palliative goals of care. He was discharged home after the EPs contacted his home hospice nu...

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Withholding and withdrawing life-support therapy in an Emergency Department: prospective survey

Abstract: Withdrawing and withholding life-support therapy involved elderly patients with underlying chronic cardiopulmonary disease or metastatic cancer or patients with acute non-treatable illness.

Cited by 70 publications

References 11 publications

Une meilleure organisation des soins pourrait diminuer le nombre des patients atteints de cancer adressés aux urgences

Une meilleure organisation des soins pourrait diminuer le nombre des patients atteints de cancer adressés aux urgences

Décisions de limitation ou d’arrêt des thérapeutiques actives dans les services d’urgence

Ethics Seminar: The Hospice Patient in the ED: An Ethical Approach to Understanding Barriers and Improving Care

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