Acute Crit Care.  2020 Aug;35(3):179-188. 10.4266/acc.2020.00136.

Decision-making regarding withdrawal of lifesustaining treatment and the role of intensivists in the intensive care unit: a single-center study

Affiliations
  • 1Department of Critical Care Medicine, Ewha Womans University College of Medicine, Seoul, Korea
  • 2Department of Surgery and Critical Care Medicine, Ewha Womans University College of Medicine, Seoul, Korea
  • 3Department of Neurology and Critical Care Medicine, Ewha Womans University College of Medicine, Seoul, Korea
  • 4Department of Anesthesiology and Critical Care Medicine, Ewha Womans University College of Medicine, Seoul, Korea

Abstract

Background
This study examined the experience of withholding or withdrawing life-sustaining treatment in patients hospitalized in the intensive care units (ICUs) of a tertiary care center. It also considers the role that intensivists play in the decision-making process regarding the withdrawal of life-sustaining treatment.
Methods
We retrospectively analyzed the medical records of 227 patients who decided to withhold or withdraw life-sustaining treatment while hospitalized at Ewha Womans University Medical Center Mokdong between April 9 and December 31, 2018.
Results
The 227 hospitalized patients included in the analysis withheld or withdrew from life-sustaining treatment. The department in which life-sustaining treatment was withheld or withdrawn most frequently was hemato-oncology (26.4%). Among these patients, the most common diagnosis was gastrointestinal tract cancer (29.1%). A majority of patients (64.3%) chose not to receive any life-sustaining treatment. Of the 80 patients in the ICU, intensivists participated in the decision to withhold or withdraw life-sustaining treatment in 34 cases. There were higher proportions of treatment withdrawal and ICU-to-ward transfers among the cases in whom intensivists participated in decision making compared to those cases in whom intensivists did not participate (50.0% vs. 4.3% and 52.9% vs. 19.6%, respectively).
Conclusions
Through their participation in end-of-life discussions, intensivists can help patients’ families to make decisions about withholding or withdrawing life-sustaining treatment and possibly avoiding futile treatments for these patients.

Keyword

euthanasia; intensive care units; resuscitation orders; terminal care; withholding treatment
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