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Title: To treat or not to treat: withholding treatment in the ICU.
Authors: Godfrey, G;Hilton, A;Bellomo, Rinaldo
Affiliation: aDepartment of Anaesthesia, Hillingdon Hospital, London, UK bDepartment of Intensive Care, Austin Hospital, Heidelberg cAustralian and New Zealand Intensive Care Research Center, Prahran, Melbourne, Victoria, Australia.
Issue Date: 1-Dec-2013
Citation: Current Opinion in Critical Care; 19(6): 624-9
Abstract: Decisions to limit life-sustaining therapy (DLLST) in the ICU are used to uphold patients' autonomy, protect them from non-beneficial treatment and fairly distribute resources. The institution of these decisions is complex, with a variety of qualitative and quantitative data published. This review aims to summarize the main issues and review the contemporary research findings on this subject.DLLST are used in a variety of clinical and non-clinical situations, before and after ICU admission, and are not always part of end-of-life management. There are many dilemmas and barriers that beset their institution. Many ICU physicians feel inadequately trained to carry them out and they are frequently a source of conflict. A variety of strategies have been examined to improve their institution, including advanced directives, intensive communication strategies and family information leaflets, many of which have improved patient and family-centred outcomes.There are a number of uncertainties that beset the institution of DLLST in the ICU; however, a variety of research has improved our ability to understand and implement them. This review frames some of the dilemmas and discusses some of the procedural strategies that have been used to improve outcomes.
Internal ID Number: 24240829
DOI: 10.1097/MCC.0000000000000036
Type: Journal Article
Subjects: Communication
Decision Making
Euthanasia, Passive.ethics.trends
Intensive Care Units
Life Support Care.ethics.psychology
Personal Autonomy
Professional-Family Relations
Terminal Care.ethics.psychology
Withholding Treatment
Appears in Collections:Journal articles

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