The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study.
10.4266/kjccm.2014.29.3.160
- Author:
Kyunghwa SHIN
1
;
Jeong Ha MOK
;
Sang Hee LEE
;
Eun Jung KIM
;
Na Ri SEOK
;
Sun Suk RYU
;
Myoung Nam HA
;
Kwangha LEE
Author Information
1. Department of Internal Medicine, Daedong Hospital, Busan, Korea.
- Publication Type:Original Article
- Keywords:
advance directives;
intensive care units;
terminal care
- MeSH:
Advance Directives;
Comorbidity;
Consent Forms;
Diagnosis;
Financing, Organized;
Humans;
Intensive Care Units*;
Male;
Medical Records;
Respiratory Insufficiency;
Retrospective Studies;
Terminal Care;
Terminally Ill
- From:The Korean Journal of Critical Care Medicine
2014;29(3):160-165
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Many terminally ill patients die while receiving life-sustaining treatment. Recently, the discussion of life-sustaining treatment in intensive care units (ICUs) has increased. This study is aimed to evaluate the current status of medical decision-making for dying patients. METHODS: The medical records of patients who had died in the medical ICU from March 2011 to February 2012 were reviewed retrospectively. RESULTS: Eighty-nine patients were enrolled. Their mean age was 65.8 +/- 13.3 years and 73.0% were male. The most common diagnosis was acute respiratory failure, and the most common comorbidity was hemato-oncologic malignancy. Withdrawing or withholding life-sustaining treatment including do-not-resuscitate (DNR) orders was discussed for 64 (71.9%) patients. In almost all cases, the discussion involved a physician and the patient's family. No patient wrote advance directives themselves before ICU admission. Of the patients for whom withdrawing or withholding life-sustaining treatment was discussed, the decisions were recorded in formal consent documents in 36 (56.3%) cases, while 28 (43.7%) cases involved verbal consent. In patients granting verbal consent, death within one day of the consent was more common than in those with formal document consent (85.7% vs. 61.1%, p < 0.05). The most common demand was a DNR order. Patients died 2.7 +/- 1.0 days after the decision for removal of life-sustaining treatment. CONCLUSIONS: The decision-making for life-sustaining treatment of dying patients in the ICU very often involves conflict. There is a general need to heighten our sensitivity on the objective decision-making based on patient autonomy.
