Life-Sustaining Treatment: Making Decisions and Appointing a Health Care Agent

JAMA ◽  
1989 ◽  
Vol 261 (13) ◽  
pp. 1984
Author(s):  
Donald J. Murphy
Keyword(s):  
Health Care ◽  
Life Sustaining Treatment ◽  
Health Care Agent

Involving Parents in Decisions to Forego Life-Sustaining Treatment for Critically Ill Infants and Children

1990 ◽  
Vol 1 (1) ◽  
pp. 206-214 ◽  
Author(s):  
Cindy Hylton Rushton ◽  
Jacqueline J. Glover
Keyword(s):  
Health Care ◽  
Critically Ill ◽  
Communication Networks ◽  
Health Care Professionals ◽  
Critically Ill Children ◽  
Best Interest ◽  
Moral Framework ◽  
Proper Role ◽  
Life Sustaining Treatment ◽  
Networks Of Support

A moral framework based on principles of beneficence and respect for persons requires shared decision-making. In the best interest of critically ill children, parents should be the primary decisionmakers in collaboration with health care professionals. When parents are unable to function in their proper role as surrogate, health care professionals must seek an alternative surrogate decisionmaker. A balanced partnership between parents and professionals can be supported by attention to the environmental stressors, enhanced communication, networks of support and institutional mechanisms for conflict resolution.

scholarly journals Cultivating Innovative Pragmatic Cluster-Randomized Registry Trials Embedded in Hemodialysis Care: Workshop Proceedings From 2018

2019 ◽  
Vol 6 ◽  
pp. 205435811989439 ◽  
Author(s):  
Elliot J. Lee ◽  
Aakil Patel ◽  
Rey R. Acedillo ◽  
Jovina C. Bachynski ◽  
Ian Barrett ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Large Scale ◽  
Poor Quality ◽  
Care Providers ◽  
Group Discussions ◽  
High Quality Research ◽  
Life Sustaining Treatment ◽  
Cluster Randomized ◽  
Health Administrators

Hemodialysis is a life-sustaining treatment for persons with kidney failure. However, those on hemodialysis still face a poor quality of life and a short life expectancy. High-quality research evidence from large randomized controlled trials is needed to identify interventions that improve the experiences, outcomes, and health care of persons receiving hemodialysis. With the support of the Canadian Institutes of Health Research and its Strategy for Patient-Oriented Research, the Innovative Clinical Trials in Hemodialysis Centers initiative brought together Canadian and international kidney researchers, patients, health care providers, and health administrators to participate in a workshop held in Toronto, Canada, on June 2 and 3, 2018. The workshop served to increase knowledge and awareness about the conduct of innovative, pragmatic, cluster-randomized registry trials embedded into routine hemodialysis care and provided an opportunity to discuss and build support for new trial ideas. The workshop content included structured presentations, facilitated group discussions, and expert panel feedback. Partnerships and promising trial ideas borne out of the workshop will continue to be developed to support the implementation of future large-scale trials.

Conscientious Refusals by Hospitals and Emergency Contraception

2011 ◽  
Vol 20 (1) ◽  
pp. 130-138 ◽  
Author(s):  
MARK R. WICCLAIR
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Sexual Assault ◽  
Emergency Contraception ◽  
Health Care Services ◽  
Goods And Services ◽  
Care Services ◽  
Catholic Health Care ◽  
Life Sustaining Treatment ◽  
Nutrition And Hydration

Hospitals sometimes refuse to provide goods and services or honor patients’ decisions to forgo life-sustaining treatment for reasons that appear to resemble appeals to conscience. For example, based on the Ethical and Religious Directives for Catholic Health Care Services (ERD), Catholic hospitals have refused to forgo medically provided nutrition and hydration (MPNH), and Catholic hospitals have refused to provide emergency contraception (EC) and perform abortions or sterilization procedures. I consider whether it is justified to refuse to offer EC to victims of sexual assault who present at the emergency department (ED). A preliminary question, however, is whether a hospital’s refusal to provide services can be conceptualized as conscience based.

The Concept of Futility in Health Care Decision Making

2004 ◽  
Vol 11 (1) ◽  
pp. 77-83 ◽  
Author(s):  
Susan Bailey
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Clinical Setting ◽  
Critical Analysis ◽  
Best Interests ◽  
Health Care Decision ◽  
Life Saving ◽  
Life Sustaining Treatment ◽  
The Individual ◽  
Care Decision

Life saving or life sustaining treatment may not be instigated in the clinical setting when such treatment is deemed to be futile and therefore not in the patient’s best interests. The concept of futility, however, is related to many assumptions about quality and quantity of life, and may be relied upon in a manner that is ethically unjustifiable. It is argued that the concept of futility will remain of limited practical use in making decisions based on the best interests principle because it places such high demands on the individual responsible for decision making. This article provides a critical analysis of futility (in the context of the best interests decision-making principle), and proposes an ethically defensible notion of futility.

scholarly journals Institution of the health care agent in Polish legislation: position of the Polish Working Group on End-of-Life Ethics

2016 ◽  
Vol 126 (5) ◽  
pp. 313-320
Author(s):  
Małgorzata Szeroczyńska ◽  
Marek Czarkowski ◽  
Małgorzata Krajnik ◽  
Romuald Krajewski ◽  
Leszek Pawłowski ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Working Group ◽  
Health Care Agent

Assessing Relationships Between Muslim Physicians’ Religiosity and End-of-Life Health-Care Attitudes and Treatment Recommendations: An Exploratory National Survey

2019 ◽  
Vol 36 (9) ◽  
pp. 780-788 ◽  
Author(s):  
Rosie Duivenbode ◽  
Stephen Hall ◽  
Aasim I. Padela
Keyword(s):  
Health Care ◽  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Religious Practice ◽  
Treatment Recommendations ◽  
Physician Attitudes ◽  
Life Care ◽  
Life Sustaining Treatment ◽  
Care Decision

Background: Research demonstrates that the attitudes of religious physicians toward end-of-life care treatment can differ substantially from their nonreligious colleagues. While there are various religious perspectives regarding treatment near the end of life, the attitudes of Muslim physicians in this area are largely unknown. Objective: This article attempts to fill in this gap by presenting American Muslim physician attitudes toward end-of-life care decision-making and by examining associations between physician religiosity and these attitudes. Methods: A randomized national sample of 626 Muslim physicians completed a mailed questionnaire assessing religiosity and end-of-life care attitudes. Religiosity, religious practice, and bioethics resource utilization were analyzed as predictors of quality-of-life considerations, attitudes regarding withholding and withdrawing life-sustaining treatment, and end-of-life treatment recommendations at the bivariate and multivariable level. Results: Two-hundred fifty-five (41% response rate) respondents completed surveys. Most physicians reported that religion was either very or the most important part of their life (89%). Physicians who reported consulting Islamic bioethics literature more often had higher odds of recommending active treatment over hospice care in an end-of-life case vignette. Physicians who were more religious had higher odds of viewing withdrawal of life-sustaining treatment more ethically and psychologically challenging than withholding it and had lower odds of agreeing that one should always comply with a competent patient’s request to withdraw life-sustaining treatment. Discussion: Religiosity appears to impact Muslim physician attitudes toward various aspects of end-of-life health-care decision-making. Greater research is needed to evaluate how this relationship manifests itself in patient care conversations and shared clinical decision-making in the hospital.

On the Edge of Death—To Intervene or Not

2020 ◽  
pp. 33-40
Author(s):  
Alexander Zoretich ◽  
Arvind Venkat
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Advance Directives ◽  
Medical Condition ◽  
Living Will ◽  
Ethical Challenges ◽  
Power Of Attorney ◽  
Medical Decisions ◽  
Life Sustaining Treatment ◽  
End Stage

Advance directives and actionable medical orders are documents that convey a patient’s wishes regarding medical treatment. Common advance directives are living will and health care power-of-attorney documents. Living wills state what a patient wants if not able to communicate for themselves and having an end-stage medical condition or permanent unconsciousness. Health care powers of attorney state whom a patient would want to make medical decisions on their behalf if not able to communicate for themselves. Both of these documents have minimal application in the emergency department given the time constraints of care in this setting. Actionable medical orders, such as Physician Orders for Life-Sustaining Treatment (POLSTs), have immediate application in the emergency department but carry their own challenges in interpretation by emergency physicians. This chapter reviews the nature of advance directives and actionable medical orders and the legal and ethical challenges posed by their application in the emergency department.

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