Ethics and End-of-life Care
Ethics and End-of-life Care
复制标题
道德与临终关怀
DOI：
10.1007/3-540-29730-8_26
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发表时间：
2006
影响因子：
--
通讯作者：
J. Curtis
中科院分区：
文献类型：
--
作者：
J. Curtis
Because of the severity of illness of patients in the intensive care unit (ICU), the ICU is a setting where death is common. Approximately 20% of all deaths in the U.S. occur in the ICU [1]. Although this proportion varies greatly in different countries, death is relatively common in most ICUs because of the severity of illness of these patients. Optimal palliative care of outpatients and patients in the acute care and long-term care settings and judicious use of the ICU for those with terminal or life-limiting illness may prevent many terminal ICU admissions. Nonetheless, the ICU will likely remain an important setting for endof-life care both because of the severity of illness of critically ill patients and because many patients with chronic, life-limiting diseases and their families opt for a trial of intensive care if there is a reasonable chance that patients may have an extension of their life with a reasonable quality of life [2]. This chapter addresses the ethical issues and challenges that arise in providing high quality care to patients who ultimately die in the ICU. Several studies have documented important shortcomings to end-of-life care in the ICU. For example, one study of six hospitals in the US showed that many patients die with moderate or severe pain [3], physicians are unaware of patients’ preferences regarding end-of-life care [4] and the care patients receive is often not consistent with their treatment preferences [3]. Another US study demonstrated signifi cant burden of symptoms among patients with cancer in the ICU [5]. Studies from the U.S. and Europe show that ICU clinicians frequently do not communicate adequately with family members [6–8]. For all these reasons, improving the quality of end-of-life care in the ICU is an ethical imperative. Perhaps one of the best ways to improve quality of end-of-life care in the ICU is to clarify the goals of care in advance of critical illness and avoid the ICU altogether when ICU-based life-sustaining therapies are unwanted or unlikely to provide benefi t. In the 1980s, many U.S. experts believed advance directives would allow patients to inform their physicians about the care they want at the end of life and to avoid technologic life-sustaining therapies at the end of life [9, 10]. Unfortunately, advance directives have not signifi cantly affected the aggressiveness or costs of ICU care [11, 12] nor have they changed end-of-life decisionmaking [13, 14]. Nonetheless, advance care planning prior to hospitalization is likely to be an important component for improving end-of-life care in the ICU [15]. However, even with excellent communication, improved prognostication, Ethics and End-of-life Care
