The incidence of withholding and withdrawing life support from the critically ill dying in an intensive care unit has increased to 50–90% of patients in recent years. At the same time, objective prognostic information to assist in decision-making, and care of dying patients are lacking.
Deciding factors of withdrawing life support include likelihood to survive the current episode and long-term survival, patient’s age, previous cognitive function, and poor expected quality of life (QOL). Other factors comprise hematological malignancy, neurological or circulatory reason for admission, length of stay, and previous physical health.
Serious concerns have been raised concerning the validity of physicians’ perceptions of patients’ QOL, the miscommunication between patients’ and their families’ decisions, and physicians’ ability to assess prognosis correctly. Moreover, a discrepancy exists between physicians’ opinions and public opinion regarding end-of-life decision-making. In addition, long-standing interventions, and expected time of death influence the decision to withdraw life support.
Reference:
Pettila, V., T. Ala-Kokko, T. Varpula, J. Laurila, and S. Hovilehto. "On What are Our End-of-life Decisions Based?" Acta Anaesthesiologica Scandinavica 46 (2002):947-54.
Cartoon obtained at:
http://www.jwolfe.clara.net/Humour/Doctors.htm
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