scholarly journals Withholding and withdrawing life-support in adults in emergency care: joint position paper from the French Intensive Care Society and French Society of Emergency Medicine

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Jean Reignier ◽  
◽  
Anne-Laure Feral-Pierssens ◽  
Thierry Boulain ◽  
Françoise Carpentier ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Intensive Care ◽  
End Of Life ◽  
Life Support ◽  
Position Paper ◽  
Emergency Setting ◽  
Intensive Care Society ◽  
Care Society ◽  
French Society

Abstract For many patients, notably among elderly nursing home residents, no plans about end-of-life decisions and palliative care are made. Consequently, when these patients experience life-threatening events, decisions to withhold or withdraw life-support raise major challenges for emergency healthcare professionals. Emergency department premises are not designed for providing the psychological and technical components of end-of-life care. The continuous inflow of large numbers of patients leaves little time for detailed assessments, and emergency department staff often lack training in end-of-life issues. For prehospital medical teams (in France, the physician-staffed mobile emergency and intensive care units known as SMURs), implementing treatment withholding and withdrawal decisions that may have been made before the acute event is not the main focus. The challenge lies in circumventing the apparent contradiction between the need to make immediate decisions and the requirement to set up a complex treatment project that may lead to treatment withholding and/or withdrawal. Laws and recommendations are of little assistance for making treatment withholding and withdrawal decisions in the emergency setting. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and French Society of Emergency Medicine (Société Française de Médecine d’Urgence, SFMU) tasked a panel of emergency physicians and intensivists with developing a document to serve both as a position paper on life-support withholding and withdrawal in the emergency setting and as a guide for professionals providing emergency care. The task force based its work on the available legislation and recommendations and on a review of published studies.

The Wessex Intensive Care Society

2006 ◽  
Vol 7 (1) ◽  
pp. 14-14
Author(s):  
Max Jonas ◽  
Tom Woodcock
Keyword(s):  
Intensive Care ◽  
Intensive Care Society ◽  
Care Society

Factors That Enable or Complicate End-of-Life Transitions in Critical Care

2005 ◽  
Vol 14 (6) ◽  
pp. 513-521 ◽  
Author(s):  
James M. Badger
Keyword(s):  
Intensive Care ◽  
End Of Life ◽  
Life Support ◽  
Treatment Options ◽  
Acute Care Hospital ◽  
Life Transitions ◽  
Care Hospital ◽  
Comfort Care ◽  
Life Threatening Illness ◽  
Medical Intensive Care

• Background Nurses in medical intensive care units are routinely involved in negotiations to maintain or withdraw life support. How nurses move from aggressively attempting to extend life to letting life end is not well understood. • Objective To explore nurses’ experiences of moving from cure- to comfort-oriented care and to describe factors that inhibit or facilitate such transitions. • Method A descriptive qualitative research design with brief observation of participants and focus group interviews was used. Participants were 19 female and 5 male nurses in an 18-bed medical intensive care unit in a 719-bed acute care hospital in the northeastern United States. • Results The transition point between cure- and comfort-oriented care was unclear. Nurses reported that the patient’s age, misunderstanding of the illness by the patient’s family, family discord, and shifting medical care decisions made end-of-life transitions difficult. Conversely, developing a consensus among patients, patients’ families, and staff about the direction of medical therapy; exhausting treatment options; and patients’ lack of response to aggressive medical interventions helped nurses move toward comfort care. • Conclusions The most distressing situations for staff were dealing with younger patients with an acute life-threatening illness and performing futile care on elderly patients. End-of-life transitions were difficult when patients’ families had conflicts or were indecisive about terminating treatment and when physicians kept offering options that were unlikely to change patients’ prognosis. The most important factor enabling nurses to move from cure- to comfort-oriented care was developing a consensus about the treatment.

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