Korean J Crit Care Med.  2015 May;30(2):73-81. 10.4266/kjccm.2015.30.2.73.

Evaluation of Informed Consent for Withholding and Withdrawal of Life Support in Korean Intensive Care Units

• Park JH
• Koh SO
• Cho JS
• Na S

• KMID: 2227665
• DOI: http://doi.org/10.4266/kjccm.2015.30.2.73

Abstract

BACKGROUND
The goal of this study was to analyze the process and characteristics of withholding or withdrawal of life support (WLS) in Korean intensive care units (ICUs).
METHODS
This was a single-centered retrospective analysis of patients who died in the ICUs of a tertiary hospital in Korea from January to December 2012. WLS informed consents and clinical data were analyzed.
RESULTS
Of 285 deaths during the study period, informed consents for WLS were obtained from 228 patients (80.0%). All WLS decisions were made by family members after the patient's loss of decision-making capacity. Decisions were made most frequently by the patient's son (50.6%). Patients in the WLS group were older than those in the non-WLS group, and older age was associated with the WLS decision. Thirty-seven patients (16.2%) died within one hour of WLS approval, and 182 patients (79.8%) died on the day of WLS approval. The most frequently withheld life support modality was chest compression (100%), followed by defibrillation (95.9%) and pacemaker insertion (63.3%).
CONCLUSIONS
Aggressive and invasive life support measures were those most frequently withheld or withdrawn by decision-makers in Korean ICUs. The most common proxy was the son, rather than the spouse.

Keyword

informed consent; intensive care units; life support care; withholding treatment

MeSH Terms

Humans
Informed Consent*
Intensive Care Units*
Korea
Life Support Care
Proxy
Retrospective Studies
Spouses
Tertiary Care Centers
Thorax
Withholding Treatment

Figure

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  Fig. 1. Patient flow chart. *Avoided list; list of withheld/withdrawn actions on the informed consent form for WLS. ICU: Intensive Care Unit; WLS: withholding and withdrawal of life support.

Reference

References

1. Jensen HI, Ammentorp J, Johannessen H, Ørding H. Challenges in end-of-life decisions in the intensive care unit: an ethical perspective. J Bioeth Inq. 2013; 10:93–101.

2. Moon JY, Shin YS. The end-of-life care in the intensive care unit. Korean J Crit Care Med. 2013; 28:163–72.

3. Ivo K, Younsuck K, Ho YY, Sang-Yeon S, Seog HD, Hyunah B, et al. A survey of the perspectives of patients who are seriously ill regarding end-of-life decisions in some medical institutions of Korea, China and Japan. J Med Ethics. 2012; 38:310–6.

4. Ryu HG, Choi JE, Lee S, Koh J, Bae JM, Heo DS. Survey of controversial issues of end-of-life treatment decisions in Korea: similarities and discrepancies between healthcare professionals and the general public. Crit Care. 2013; 17:R221.

5. Jo KH, An GJ. Factors affecting shared decision making at end of life in Korean adults. Holist Nurs Pract. 2013; 27:329–35.

6. Supreme Court Decision 2002Do995 Decided. 6. 24. 2004.

7. Aita K, Takahashi M, Miyata H, Kai I, Finucane TE. Physicians’ attitudes about artificial feeding in older patients with severe cognitive impairment in Japan: a qualitative study. BMC Geriatr. 2007; 7:22.

8. Kim SH, Son MS, Koh SO, Lee IH. Intensive care provider’s perceptions of medically futile treatment: Focus group interviews. Korean J Med Ethics. 2012; 15:370–84.

9. Kim S, Kang H, Koh Y, Koh S. Attitudes and practices of critical care physicians in end-of-life decisions in Korean intensive care units. Korean J Med Ethics. 2009; 12:12–28.

10. Sprung CL, Carmel S, Sjokvist P, Baras M, Cohen SL, Maia P, et al. Attitudes of European physicians, nurses, patients, and families regarding end-of-life decisions: the ETHICATT study. Intensive Care Med. 2007; 33:104–10.

11. Morita T, Miyashita M, Shibagaki M, Hirai K, Ashiya T, Ishihara T, et al. Knowledge and beliefs about end-of-life care and the effects of specialized palliative care: a population-based survey in Japan. J Pain Symptom Manage. 2006; 31:306–16.

12. Esteban A, Gordo F, Solsona JF, Alia I, Caballero J, Bouza C, et al. Withdrawing and withholding life support in the intensive care unit: a Spanish prospective multi-centre observational study. Intensive Care Med. 2001; 27:1744–9.

13. Buckley TA, Joynt GM, Tan PY, Cheng CA, Yap FH. Limitation of life support: frequency and practice in a Hong Kong intensive care unit. Crit Care Med. 2004; 32:415–20.

14. Yazigi A, Riachi M, Dabbar G. Withholding and withdrawal of life-sustaining treatment in a Lebanese intensive care unit: a prospective observational study. Intensive Care Med. 2005; 31:562–7.

15. Lee JK, Cho KI, Park CH, Cho SJ. Last 10 year’s statistics of newborn baby’s sex ratio in multigravide at Taegu Catholic Medical Center. Korean J Obstet Gynecol. 1993; 36:3565–75.

16. Prendergast TJ, Luce JM. Increasing incidence of withholding and withdrawal of life support from the critically ill. Am J Respir Crit Care Med. 1997; 155:15–20.

17. Sprung CL, Cohen SL, Sjokvist P, Baras M, Bulow HH, Hovilehto S, et al. End-of-life practices in European intensive care units: the Ethicus Study. JAMA. 2003; 290:790–7.

18. Lee K, Jang HJ, Hong SB, Lim CM, Koh Y. Do-not-resuscitate order in patients, who were deceased in a medical intensive care unit of an university hospital in Korea. Korean J Crit Care Med. 2008; 23:84–9.

19. Li LB. Clinical review: Ethics and end-of-life care for critically ill patients in China. Crit Care. 2013; 17:244.

20. Ferrand E, Robert R, Ingrand P, Lemaire F; French LATAREA Group. Withholding and withdrawal of life support in intensive-care units in France: a prospective survey. French LATAREA Group. Lancet. 2001; 357:9–14.

21. de Camargo Cancela M, Comber H, Sharp L. Age remains the major predictor of curative treatment non-receipt for localised prostate cancer: a population-based study. Br J Cancer. 2013; 109:272–9.

22. Hamel MB, Teno JM, Goldman L, Lynn J, Davis RB, Galanos AN, et al. Patient age and decisions to withhold life-sustaining treatments from seriously ill, hospitalized adults. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Ann Intern Med. 1999; 130:116–25.

23. Nakagawa K, Vento MA, Seto TB, Koenig MA, Asai SM, Chang CW, et al. Sex differences in the use of early do-not-resuscitate orders after intracerebral hemorrhage. Stroke. 2013; 44:3229–31.

24. Kranidiotis G, Gerovasili V, Tasoulis A, Tripodaki E, Vasileiadis I, Magira E, et al. End-of-life decisions in Greek intensive care units: a multicenter cohort study. Crit Care. 2010; 14:R228.

25. Azoulay E, Metnitz B, Sprung CL, Timsit JF, Lemaire F, Bauer P, et al. End-of-life practices in 282 intensive care units: data from the SAPS 3 database. Intensive Care Med. 2009; 35:623–30.

26. Heo DS. Life-sustaining medical treatment for terminal patients in Korea. J Korean Med Sci. 2013; 28:1–3.

27. National Evidence-based Healthcare Collaborating Agency. Social consensus for withdrawal of futile life-sustaining treatments. seoul,korea: 2009.

28. Hartog CS, Peschel I, Schwarzkopf D, Curtis JR, Westermann I, Kabisch B, et al. Are written advance directives helpful to guide end-of-life therapy in the intensive care unit? A retrospective matched-cohort study. J Crit Care. 2014; 29:128–33.

29. Sun DS, Chun YJ, Lee JH, Gil SH, Shim BY, Lee OK, et al. Recognition of advance directives by advanced cancer patients and medical doctors in hospice care ward. Korean J Hosp Palliat Care. 2009; 12:20–6.