Academic literature on the topic 'Withdrawal of life-sustaining interventions'
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Journal articles on the topic "Withdrawal of life-sustaining interventions"
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Curtis, J. Randall. "Interventions to Improve Care during Withdrawal of Life-Sustaining Treatments." Journal of Palliative Medicine 8, supplement 1 (December 2005): s—116—s—131. http://dx.doi.org/10.1089/jpm.2005.8.s-116.
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Campbell, ML, and MC Thill. "Impact of patient consciousness on the intensity of the do-not-resuscitate therapeutic plan." American Journal of Critical Care 5, no. 5 (September 1, 1996): 339–45. http://dx.doi.org/10.4037/ajcc1996.5.5.339.
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BACKGROUND: The nature and intensity of a do-not-resuscitate therapeutic plan varies by patient. Some do-not-resuscitate therapeutic plans may include interventions directed at the withdrawal of life-sustaining therapy. OBJECTIVE: The purpose of this study was to examine the impact of patient consciousness on the nature and intensity of the do-not-resuscitate plan, and on the decision to withdraw life-sustaining therapy. METHODS: This study represents a secondary analysis of data obtained in a previous study to evaluate patient care requirements under varying intensities of do-not-resuscitate plans. Data were collected retrospectively through record review. Patients were grouped as follows, according to the intensity of the do-not-resuscitate plan: (1) all but cardiopulmonary resuscitation, (2) conservative care without cardiopulmonary resuscitation, (3) comfort only, and (4) withdrawal of life-sustaining therapy. In addition to demographic data, consciousness and illness severity were measured. Data were analyzed using descriptive statistics. RESULTS: There was a significant decrease in consciousness from admission in all groups except conservative care. The withdrawal group had the lowest average Glasgow Coma Scale scores at the time of the do-not-resuscitate designation. Multiple regression analysis was used to demonstrate a significant impact of consciousness on type of do-not-resuscitate decision, but no significant impact from age or illness severity. CONCLUSIONS: These results support previous observations that decisions to withdraw life-sustaining therapy are prompted by diminished consciousness. These results may stimulate caregivers to offer withdrawal of life-sustaining therapy as an option in patients with severely decreased consciousness and a poor prognosis for functional recovery.
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Wagner, Ira J. "Private Attending Physician Status and the Withdrawal of Life-Sustaining Interventions." Critical Care Medicine 25, no. 2 (February 1997): 375. http://dx.doi.org/10.1097/00003246-199702000-00030.
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Kollef, Marin H. "Private Attending Physician Status and the Withdrawal of Life-Sustaining Interventions." Critical Care Medicine 25, no. 2 (February 1997): 375. http://dx.doi.org/10.1097/00003246-199702000-00031.
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Kramer, Andreas H., and Christopher J. Doig. "Premortem Heparin Administration and Location of Withdrawal of Life-Sustaining Interventions in DCD." Transplantation 100, no. 10 (October 2016): e102-e103. http://dx.doi.org/10.1097/tp.0000000000001378.
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Campbell, ML, and RW Carlson. "Terminal weaning from mechanical ventilation: ethical and practical considerations for patient management." American Journal of Critical Care 1, no. 3 (November 1, 1992): 52–56. http://dx.doi.org/10.4037/ajcc1992.1.3.52.
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Decisions to withdraw life-sustaining therapy are being made more often as patients and healthcare providers increase their awareness of patient rights. The process of withdrawal of mechanical ventilation must be conducted in a humane fashion. An understanding of the ethical, legal and practical considerations for patient management during this type of intervention will enhance the ability of the healthcare provider to participate.
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Barker, Virgil M. "Deactivation of Pacemakers at the End of Life." Ethics & Medics 44, no. 9 (2019): 1–2. http://dx.doi.org/10.5840/em201944912.
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The liceity of deactivating pacemakers and implantable cardio-defibrillators at the end of life has been considered only recently. The current discussion divides into two main camps: those who view deactivation as the moral equivalent of the withdrawal of other life-sustaining interventions, and those who hold deactivation as the equivalent of physician-assisted suicide. Some authors contend that similar to a transplanted organ, the pacemaker establishes an organic unity with the human body. Hence, its deactivation is equivalent to the removal or disabling of an organ. On the contrary, the relationship of a pacemaker to the human body is similar to other supportive mechanical devices. There are burdens associated with the presence of these devices. In the face of a terminal diagnosis, the deactivation of a cardio-pacemaker is morally similar to the withdrawal of other extraordinary measures currently accepted within the Catholic moral teachings.
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Kollef, Marin H. "Private attending physician status and the withdrawal of life-sustaining interventions in a medical intensive care unit population." Critical Care Medicine 24, no. 6 (June 1996): 968–75. http://dx.doi.org/10.1097/00003246-199606000-00016.
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RICH, BEN A. "The Tyranny of Judicial Formalism: Oral Directives and the Clear and Convincing Evidence Standard." Cambridge Quarterly of Healthcare Ethics 11, no. 3 (May 17, 2002): 292–302. http://dx.doi.org/10.1017/s0963180102113119.
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A decision by the Supreme Court of California in the case Conservatorship of Wendland, issued in August 2001, forces us once again to confront the all-too-common situation in which an individual has, on multiple occasions, expressed strongly held personal convictions about life-sustaining interventions but failed to incorporate those convictions into a formal advance directive. Many courts have recognized that lay citizens do not consistently resort to written legal formalities in their day-to-day lives, and reasonable accommodation must be made to this fundamental fact about human nature. However, a small but apparently growing minority of courts adamantly insist on either formal written directives or prescience and prophetic precision on the part of the patient before a surrogate can direct the withdrawal of life-sustaining treatment. The chronology of cases that comprise this minority position in American medical jurisprudence raise important ethical issues.
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Yun, Young Ho, Kyoung-Nam Kim, Jin-Ah Sim, Shin Hye Yoo, Miso Kim, Young Ae Kim, Beo Deul Kang, et al. "Comparison of attitudes towards five end-of-life care interventions (active pain control, withdrawal of futile life-sustaining treatment, passive euthanasia, active euthanasia and physician-assisted suicide): a multicentred cross-sectional survey of Korean patients with cancer, their family caregivers, physicians and the general Korean population." BMJ Open 8, no. 9 (September 2018): e020519. http://dx.doi.org/10.1136/bmjopen-2017-020519.
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ObjectivesThis study determined attitudes of four groups—Korean patients with cancer, their family caregivers, physicians and the general Korean population—towards five critical end-of-life (EOL) interventions—active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide.Design and settingWe enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association. We analysed the associations of demographic factors, attitudes towards death and the important components of a ‘good death’ with critical interventions at EoL care.ResultsAll participant groups strongly favoured active pain control and withdrawal of futile LST but differed in attitudes towards the other four EoL interventions. Physicians (98.9%) favoured passive euthanasia more than the other three groups. Lower proportions of the four groups favoured active euthanasia or PAS. Multiple logistic regression showed that education (adjusted OR (aOR) 1.77, 95% CI 1.33 to 2.36), caregiver role (aOR 1.67, 95% CI 1.34 to 2.08) and considering death as the ending of life (aOR 1.66, 95% CI 1.05 to 1.61) were associated with preference for active pain control. Attitudes towards death, including belief in being remembered (aOR 2.03, 95% CI 1.48 to 2.79) and feeling ‘life was meaningful’ (aOR 2.56, 95% CI 1.58 to 4.15) were both strong correlates of withdrawal of LST with the level of monthly income (aOR 2.56, 95% CI 1.58 to 4.15). Believing ‘freedom from pain’ negatively predicted preference for passive euthanasia (aOR 0.69, 95% CI 0.55 to 0.85). In addition, ‘not being a burden to the family’ was positively related to preferences for active euthanasia (aOR 1.62, 95% CI 1.39 to 1.90) and PAS (aOR 1.61, 95% CI 1.37 to 1.89).ConclusionGroups differed in their attitudes towards the five EoL interventions, and those attitudes were significantly associated with various attitudes towards death.
Dissertations / Theses on the topic "Withdrawal of life-sustaining interventions"
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Pilotte, Janice Lee Fitzherbert. "Withdrawal/Withholding Life-Sustaining Therapies: Factors that Influence Family Decisions." Fogler Library, University of Maine, 2005. http://www.library.umaine.edu/theses/pdf/PilotteJLF2005.pdf.
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Gerges, Peter Raouf Aziz. "Effect of intensity of care on mortality and withdrawal of life-sustaining therapies in severe traumatic brain injury patients : a post-hoc analysis of a multicenter cohort study." Master's thesis, Université Laval, 2017. http://hdl.handle.net/20.500.11794/30951.
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Introduction et objectifs Le traumatisme craniocérébral (TCC) est un problème de santé majeur dans le monde. Chez les patients ayant subi un TCC grave, une amélioration de la mortalité a été observée dans les centres de traumatologie offrant une intensité de traitement élevée et un monitorage intensif. Cependant, la mortalité ainsi que l’incidence du retrait du maintien des fonctions vitales varient entre les différents centres de traumatologie. Notre étude visait à évaluer l’association en l’effet de l'intensité des soins sur l’incidence du retrait du maintien des fonctions vitales et de mortalité chez les patients ayant subi un TCC grave. Méthodes Notre étude est une analyse post-hoc d’une étude cohorte rétrospective multicentrique de patients ayant subi un TCC grave (n = 720). Nous avons défini l’intensité des soins en utilisant le type d’interventions effectuées à l’'unité de soins intensifs. Les interventions ont été classées en fonction de leur spécificité par rapport au TCC et en fonction de leur nature : 1) médicale, 2) chirurgicale, et 3) diagnostique. L’effet de l'intensité des soins, sur la mortalité et le retrait du maintien des fonctions vitales, a été évalué en utilisant des modèles à risques proportionnels de Cox ajustés. Résultats L’intensité des soins a été associée à une diminution de la mortalité (HR 0,69, IC à 95% 0,63 à 0,74, p <0,0001) et du retrait du maintien des fonctions vitales (HR 0,73, IC à 95% 0,67 à 0,79, p <0,0001). Les associations ont été significatives pour l'intensité des interventions spécifiques et non-spécifiques au TCC et pour les interventions médicales et diagnostiques, mais non significatives pour les interventions chirurgicales. Conclusion Nous avons observé une association significative entre l'intensité globale des soins sur la mortalité et sur l'incidence du retrait du maintien des fonctions vitales suivant un TCC grave. Cette association était significative avec les interventions spécifiques et non-spécifiques au TCC, ainsi qu’avec les interventions médicales et diagnostiques.Introduction and objectives Traumatic brain injury (TBI) is a major health problem. In severe TBI, better outcomes and reduced mortality were shown in trauma centers providing high intensity of treatment and monitoring. Mortality as well as incidence of withdrawal of life-sustaining therapies were found to vary among different trauma centers. Our study aimed to evaluate the effect of intensity of care for severe TBI on the incidence of withdrawal of life-sustaining therapy and mortality. Methods Our study is post-hoc analysis of a Canadian multicenter retrospective cohort study of patients with severe TBI (n = 720). We defined the intensity of care using interventions performed in ICU. They were categorized into 1) TBI related interventions, 2) interventions non-specific to TBI, and according to type of interventions: 1) medical, 2) surgical, and 3) diagnostic interventions. The effect of intensity of care, on mortality and the withdrawal of life-sustaining therapies, was evaluated with adjusted Cox proportional-hazards regression analyses of time-to-event data. Results The intensity of care was associated with decreased mortality (HR 0.69, 95% CI 0.63–0.74, p<0.0001) and decreased withdrawal of life support (HR 0.73, 95% CI 0.67–0.79, p<0.0001). The associations with outcomes were also significant for both the intensity of interventions specific to TBI and general ICU interventions. The associations with outcomes also maintained their significance with medical and diagnostic components of care but were not significant with surgical component of care. Conclusion We observed a significant association between the overall intensity of care, defined by the different interventions commonly used, on mortality and on the incidence of withdrawal of life-sustaining therapies in severe TBI. This association was present whether interventions were specific or not specific to TBI, as well as whether they were medical or diagnostic interventions.
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Rydvall, Anders. "Withhold or withdraw futile treatment in intensive care : arguments supported by physicians and the general public." Doctoral thesis, Umeå universitet, Anestesiologi och intensivvård, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-128863.
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Background: Since the 60s and with increasing intensity a discussion have continued about balance between useful and useless/harmful treatment. Different attempts have been done to create sustainable criteria and recommendations to manage the situations of futile treatment near the end of life. Obviously, to be able to withhold (WH) or withdraw (WD) treatment which is no longer appropriate or even harmful and burdensome for the patient, other processes than strict medical (or physiological) assessments are necessary. Aim. To shed light on the arguments regarding to WH or WD futile treatment we performed two studies of physicians’ and the general populations’ choice and prioritized arguments in the treatment of a 72-year-old woman suffering from a large intra-cerebral bleeding with bad prognosis (Papers I and II) and a new born boy with postpartum anoxic brain damage (Papers III and IV). Methods. Postal questionnaires based on two cases presented above involving severely ill patients were used. Arguments for and against to WH or WD treatment, and providing treatment that might hasten death were presented. The respondents evaluated and prioritized arguments for and against withholding neurosurgery, withdrawing life-sustaining treatment and providing drugs to alleviate pain and distress. We also asked what would happen to physicians’ own trust if they took the action described, and what the physician estimated would happen to the general publics’ trust in health services (Paper IV). Results. Approximately 70% of the physicians and 46% of the general public responded in both surveys. The 72-year-old woman: A majority of doctors (82.3%) stated that they would withhold treatment, whereas a minority of the general public (40.2%) would do so; the arguments forwarded and considerations regarding quality of life differed significantly between the two groups. Quality-of-life aspects were stressed as an important argument by the majority of both neurosurgeons and ICU-physicians (76.8% vs. 54.0%); however, significantly more neurosurgeons regarded this argument as the most important. A minority in both groups, although more ICU-physicians, supported a patient’s previously expressed wish of not ending in a persistent vegetative state as the most important argument. As the case clinically progressed, a consensus evolved regarding the arguments for decision making. The new born child: A majority of both physicians [56 % (CI 50–62)] and the general population [53 % (CI 49–58)] supported arguments for withdrawing ventilator treatment. A large majority in both groups supported arguments for alleviating the patient’s symptoms even if the treatment hastened death, but the two groups display significantly different views on whether or not to provide drugs with the additional intention of hastening death, although the difference disappeared when we compared subgroups of those who were for or against euthanasia-like actions. Conclusions. There are indeed considerable differences in how physicians and the general public assess and reason in critical care situations, but the more hopelessly ill the patient became the more the groups' assessments tended to converge, although they prioritized different arguments. In order to avoid unnecessary dispute and miscommunication, it is important that health care providers are aware of the public's views, expectations, and preferences. Our hypothesis—physicians’ estimations of others’ opinions are influenced by their own opinions—was corroborated. This might have implications in research as well as in clinical decision-making.
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Andersson, Matilda, and Nicole Häggqvist. "När är det dags att dö? : Läkares och sjuksköterskors resonemang kring att avstå och avbryta livsuppehållande behandling på en intensivvårdsavdelning." Thesis, Umeå universitet, Institutionen för omvårdnad, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-180564.
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Bakgrund: Beslut om att avstå och avbryta livsuppehållande behandling har de senaste åren ökat i antal inom intensivvården i Europa. Intensivvårdspatienter har ofta nedsatt autonomi, och läkare och sjuksköterskor måste därför försöka avgöra vad som är rätt för patienten. Detta kan orsaka moralisk stress eftersom att det inte finns några enhetliga riktlinjer för när den livsuppehållande behandlingen övergår till att vara meningslös. Motiv: Beslut kring att avstå eller avbryta livsuppehållande behandling kan vara ett mångfacetterat etiskt beslut som försvåras av intensivvårdspatientens nedsatta autonomi. Den föreliggande studien syftar till att belysa de etiska utmaningar som uppstår när beslutet ska fattas. Syfte: Att belysa läkares och sjuksköterskors resonemang kring att avstå och avbryta livsuppehållande behandling på en intensivvårdsavdelning. Metod: En vinjettstudie genomfördes med individuella semistrukturerade intervjuer med intensivvårdsläkare (n=5) och intensivvårdssjuksköterskor (n=5). Insamlad data analyserades med kvalitativ innehållsanalys. Resultat: Deltagarnas resonemang kring att avstå och avbryta livsuppehållande behandling utmynnade i nio subteman som delades in i tre olika teman; Strävan efter att göra gott, Involvering av närstående och Behov av reflektion i teamet. Konklusion: Teamet ansågs betydelsefullt i beslut kring livsuppehållande behandling. Det fanns ibland olika uppfattningar inom teamet kring vilken behandling som gagnar patienten och vidare forskning behövs kring metoder, exempelvis etiska ronder, för att överbrygga dessa meningsskiljaktigheter. Om de etiska utmaningarna läkare och sjuksköterskor upplever kring beslut att avstå eller avbryta livsuppehållande behandling uppmärksammas och diskuteras, ökar chanserna för att alla involverade känner att rätt beslut fattas för patienten som individ.Background: There is an increase of decisions to withhold or withdraw life sustaining treatment within intensive care units in Europe. Intensive care patients often have a limited autonomy and physicians and nurses therefore have to decide what is right for the patient. This can cause moral stress due to a lack of unitary guidelines for when life sustaining treatment becomes futile. Motive: Decisions to withhold or withdraw life sustaining treatment can be a multifaceted ethical dilemma that is complicated by the intensive care patients' limited autonomy. This study aims to illustrate the ethical challenges occurring when this decision is to be made. Aim: To illustrate the reasoning of physicians' and nurses' about withholding and withdrawing life sustaining treatment in an intensive care unit. Methods: A vignette study was conducted with individual semi structured interviews with intensive care physicians (n=5) and intensive care nurses (n=5). Collected data was analysed with qualitative content analysis. Result: The participants reasoning to withhold or withdraw life sustaining treatment resulted in nine subthemes that was further divided into three themes; Striving to do good, Involment of relatives and A need to reflect within the team. Conclusion: The team was considered important in decisions regarding life- sustaining treatment. Sometimes there were different views within the team about what treatment would benefit the patient and further research is needed of methods, such as ethical rounds to overcome disagreements regarding decisions to withhold and withdraw life-sustaining treatment within intensive care. If these ethical challenges experienced by physicians and nurses due to these decisions are acknowledged and discussed, chances increase that everyone involved feels that the right decision is made for the patient as an individual.
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Dorval, Geneviève. "La transition du curatif aux soins de fin de vie en néonatologie : une ethnographie de la prise de décision chez les soignants." Thèse, 2016. http://hdl.handle.net/1866/18401.
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Ce mémoire de maîtrise en anthropologie est le résultat d’une recherche de terrain menée au service de néonatologie du CHU Sainte-Justine et ayant pour objectif de documenter les pratiques décisionnelles entourant l’arrêt des traitements curatifs chez les patients. La fin de vie de ces patients est traversée par des enjeux de nature éthique, socioculturelle et professionnelle. Par le biais d’observations prolongées et d’entretiens menés auprès de soignants de ce service, ces fins de vie se sont révélées tissées d’incertitude et propices aux divergences d’opinions. Loin d’être distribuées de manière arbitraire, ces divergences se dessinent souvent en fonction des corps de métiers. Elles ont donc été étudiées en relation avec l’organisation du travail en néonatologie pour saisir l’influence qu’exerce cette dernière sur la formation des valeurs et des postures morales des soignants. Les rapports qu’entretiennent les professionnels avec l’incertitude, ainsi que le partage (ou non) de la prise de décision au sein de l’équipe soignante se rattachent à ces postures morales et dévoilent des dynamiques sociales et organisationnelles à l’oeuvre dans ce service hospitalier. En dernier lieu, le travail en néonatologie fut observé à la loupe des dimensions cure et care des soins de santé. Depuis cette optique, la fin de vie apparaît comme une occasion de prise en charge qui reconnaît la singularité et l’humanité des soignants comme des soignés.This master's thesis in anthropology is the result of fieldwork conducted in the neonatal intensive care unit of the CHU Sainte-Justine. It aims to document the decision-making practices regarding the withdrawal of life-sustaining interventions. The patients’ end-of-life treatment decisions are underpinned by ethical, socio-cultural, and professional issues. Through extended observations and interviews with caregivers from this service, these situations have proven to be riddled with uncertainty and characterized by differences of opinion. Far from being randomly distributed, these differences are generally divided along the lines of the medical and nursing professions. This study therefore concentrates on the organization of work in neonatology to better understand its influence on the formation of values and moral stances. The healthcare professionals’ relationship with uncertainty, as well as the choice to share or not the decision-making process within the healthcare team, are connected to these moral positions and reveal social and organizational dynamics at work within this hospital department. Finally, work in neonatology is observed through the lens of the cure and care dimensions of healthcare. From this perspective, end-of-life situations appear as an opportunity to offer care while recognizing the singularity and humanity of both caregivers and care receivers.
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Lin, Chen-Wei, and 林珍瑋. "The predictors of withdrawal of life-sustaining treatments and the impacts of life-sustaining treatments on survival time among terminally ill patients at intensive care unit." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/6psnq8.
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碩士國立臺灣大學
護理學研究所
106
Background: The withdrawing life support for terminally ill patients is developed to meet their wishes for not maintaining their lives with machines, and providing palliative care to enhance their comfort. However, even after families have given the consent for withholding or withdrawal of life support for their ill family members, they are reluctant to withdrawal some medical intervention. While in the recent years, this issue has been done in overseas, very few researchers explore this issue in Taiwan. Research purpose: This study aims to explore the following issues among the terminally ill patients in medical intensive care units (MICU): 1. the incidence and time of withdrawal of life support decisions and the main predictors associated with their decisions; 2. type and lengths of receiving life support treatments; 3. the impacts of life support medical interventions on the mortality in period of MICU and one-year after discharge from MICU. Methods: This study adopts a retrospective longitudinal study. We collected data from January 2016 to December 2016 by chart review of medical servicesamong the terminally ill patients from four MICUs in the general hospital. The inclusion criteria for this study were the patients who had signed “Do Not Resuscitate” forms and are diagnosed as terminally ill patients by two specialists. The date of admission to the MICU, date of death or discharge from the MICU, epidemiological information, disease information, date of signing a “withdrawal of life support consent”, and types and lengths of medical interventions received in the MICU. Results: The results of this study are based on the 326 terminal patients. The rates of consent for withdrawal of life support were 10.4% (34/326), average time of consenting to withdrawal is13.09 days (SD±5.57) after MICU admission, and average time from providing the written consents to implementing withdrawal of life support were 1.74 days (SD±1.52). Compared to the patients without the written consent for withdrawal, the patients who had signed “withdrawal of life support consents” were younger at an average age of 58.97 years old (SD±16.44), had less supports from social welfare (58.8%), had the higher percentages of cancer or cardiac diseases as the major diagnosis (20.6%), had higher average scores of Apache II for disease severity, and had a shorter length in MICU (14.79 days). Logistic regression model showed that age and Apache II disease severity were associated with the providing writeen consent for “withdrawal of life support”. The older patients were 0.965 times (p=0.004) likely provided the consent for withdrawal of life support than the younger patients. Patients with higher Apache II scores of disease severity were 1.045 times more likely to give consent for withdrawal of life support than patients with lower Apache II scores (p=0.017). The major reason for the families providing the written consent for “withdrawal of life support” was wishing no more suffering for their illfamily members (58.8%). The major reason for refusing to give the written consent for withdrawal of life support was to have the hope for being alive after the medical treatments (87.5%). The most common withdrawn life support was the ventilator (64.7%). Compared to the patients without providing the written consent, patients with written consent for “withdrawal of life support” received more high-dose inotropic agent and vasopressors (x2=4.253, p= 0.039), continuous intravenous fluid support (x2=4.686, p= 0.03), sedative drugs treatment (x2=5.713, p= 0.017), and ECMO treatment (x2=7.567, p= 0.014) while they received less tracheostomy operations (x2=4.631, p=0.031) and enteral nutrition (x2=11.45, p= 0.001). The results of COX regression model showed that after controlling Apache II scores, compared with the patients without receiving the following life support treatments, the odds ratios of the mortality for the patients who received these treatments were 0.451 for oxygen therapy, 0.275 for enteral nutrition, 0.434 for non-enteral nutrition, 0.625 for continuous intravenous fluid support, 0.487 for blood transfusion, and inotropic agents and vasopressors. Compared with the patients without receiving these treatments, the odds ratios for one-year mortality for the patients who received these treatments were: 0.545 for oxygen therapy, 0.381 for enteral nutrition, 0.562 f or non-enteral nutrition, 0.677 for continuous intravenous fluid support, 0.666 for blood transfusions, and 2.096 for inotropic agents and vasopressors. Theree were no significant differences in the mortality between with and without receiving the treatments of ventilator use (invasive and non-invasive), hemodialysis, antibiotics treatment, blood draws, and sedative drugs use. Conclusions: The incidence rates of providing written consent for withdrawal of life support are low. The main factors associated with providing written consent were younger age and higher levels of disease severity. The main reason for families providing the written consent was wishing no more suffering for their ill family members. The treatments of inotropic agents and vasopressors likely increase the risks of mortalityat the time of ICU and one year after discharging from ICU for the terminally ill patients. The treatments ofoxygen therapy, enteral nutrition, non-enteral nutrition, intravenous fluid support and blood transfusions likely reduce the risk of their mortality. No significant impacts of ventilator use (invasive and non-invasive), hemodialysis, antibiotics treatment, blood draws, and sedative drugs on the risks of mortality were found at the time of ICU and one year after discharge from ICU. In the future, more survival studies on the impacts of life support treatments on the risk of mortality are required to help the terminally ill patients away from ineffective treatments.
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Chiu, Shu-Chen, and 邱淑珍. "A Preliminary Study on Experiences of Medical Social Workers Participating in Withdrawal of Life-Sustaining Treatment." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/493xma.
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碩士國立臺灣師範大學
社會工作學研究所
105
High-standard end-of-life patient care should be in line with the patient and family-centered decision-making mode, including a good communication mechanism, continuous care, comfortable treatment, avoidance of pain, emotional comfort, substantial care and spirit support. In this study, we conducted in-depth interviews with four senior social workers with over 14 years of experience in the medical social work field about ethical dilemmas they faced when the medical team removed life-sustaining treatment, their role in this process, their interaction with the medical team and family members and how they dealt with the issues. First, we divided the life-sustaining treatment withdrawal process into four phases: initiation phase, decision-making phase, removal or termination preparation phase and the final phase. With respect to the functions of a medical social worker provided in the team, the social worker needs to clarify the position of family members by communication and coordination, stabilize the emotion of patient/family and team members, assist in assessing the legality of the implementation process and educate the members of the life-sustaining treatment withdrawal team. In terms of the work with family members, the social worker’s main job is to serve as a communication bridge between the medical team and the patient/family, accompany the patient and family during the adaptation process and be attentive to the family’s sorrow. The dilemmas faced by the medical social workers were their reluctance to see the patients suffering and the family struggle on making medical decisions and worry about their financial ability. Finally, in order to provide appropriate service, and establish and enhance knowledge and ability, the medical social workers usually studied medicine-related knowledge on their own and actively participated in self-growth learning in addition to the training provided by the hospital or the department. Peer supervision and self-learning provided great support. Based on the experience in the withdrawal of life-sustaining treatment, these senior medical social workers agreed that it requires a certain degree of work experience to work more smoothly in the team and experiences are accumulated through active learning. The findings of this study can be the recommendations for medical and other related team members.
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Chang, Chang-Wen, and 張佳雯. "The study of the intention and related factors toward withdrawal of life sustaining treatment in health care providers." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/rqr334.
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Mathye, Lethabo Violet. "Therapeutic techniques for treatment of adolescents with rebellious behaviour." Thesis, 2004. http://hdl.handle.net/10500/1430.
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This study focuses on the therapeutic interventions by mental health practitioners when faced with rebellious youths.
Rebelliousness refers to the act of defying lawful authority or a resistant way of relating to authority or convention. It is manifested in, amongst others, withdrawal, deviance, delinquency, antisocial behaviour, and suicide.
To date there are no interventions for rebellious youths per sé. Rebellious youths are often treated with traditional strategies which are often ineffective and show little promise for eliminating rebellious behaviour. Research has revealed that teen problem behaviours stem from "life-problems" such as psychosocial stressors. Therefore treating the adolescent for substance abuse, for example, is treating him/her for the wrong reasons. It is no surprise that many adolescents who have undergone intervention programmes for specific behaviour problems relapse soon after they are released from the programmes.
The study focuses on integrating different strategies in order to combat rebelliousness in adolescence and beyond. This holistic approach argues that all treatments share certain curative processes. Therefore each treatment works best when it is combined with other aspects of treatment. For this reason, individual, family and group therapy were combined together with school strategies.
The results of this study indicate that combining procedures that are designed to improve problematic behaviour in teenagers are viable forms of treatment.Educational Studies
D.Ed.(Psychology of Education)
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Lin, Yun-Ju, and 林芸如. "Knowledge, Attitude and Associated Factors of Healthcare Professionals to Hospice Palliative Care and Withdrawal Life-sustaining Treatment : A Case of Regional Teaching Hospital in Southern Taiwan." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/d5usf9.
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碩士美和科技大學
護理系健康照護碩士班
106
Background: In the past, Taiwan conducted a series of studies on peace withdraw life sustaining, and did less comprehensive discussion on medical staff's. Purpose: The purpose of this study was to explore the medical staff's knowledge, attitude and associated factors of hospice palliative care and withdrawal life-sustaining treatment. Methods: In this study, a total of 406 medical staffs in a teaching hospital in a southern part of the country were selected for the transection study and the intention sampling. Three questionnaires including " Hospice Palliative Care Awareness Scale" ,”Withdrawal Life-Sustaining Treatment Awareness Scale " and " Withdrawal Life-sustaining Treatment Attitude Scale " were used in this study. By the way, descriptive statistics, independent sample T test, one-way analysis of variance, Pierson correlation, snow burden after the test and complex regression analysis were used for statistical analyses. Results:The overall average score of hospice palliative care and withdrawal life-sustaining treatment was 25.84 (0-31 points), and the average withdrawal life-sustaining treatment attitude was 3.58 (1-5 points), which significantly affected the " hospice palliative care and withdrawal life-sustaining treatment the definition of cues to " palliative /hematoma divisions ", " high seniority ", " health care workers ", " palliative care experience" and "knowing the status of the law revision in 2013", explaining a variance of 16.4%. The key influencing factors for the "attitude of withdrawal life-sustaining treatment " are " palliative /hematoma divisions ", " the older " and " knowledge " and the important explanatory factors were 8.6%. Conclusions /Implictions of Practice: This study found that hospice palliative care of the higher, the attitude of withdrawal life-sustaining treatment is high, only in tranquility and hematoma department medical staff palliative care experience then more, with the highest knowledge, but the lowest attitude, cognitive education can be improved. However, there is a need to improve the attitudes toward clinical care, the patient and family members' emotions, and the consensus of their families in decision-making. The results of this study can provide reference for palliative care and wthdraw life sustaining.
Books on the topic "Withdrawal of life-sustaining interventions"
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Childress, James F. An ethical analysis of withdrawal from life-sustaining technologies and assisted death: A report for the Office of Technology Assessment. [Washington, D.C.?: The Office, 1985.
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Fogelman, Patricia Maani, and Janine A. Gerringer. Withdrawal of Cardiology Technology. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190204709.003.0011.
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The care of the cardiac patient requires exquisite assessment including history, physical examinations, and diagnostic data in order to make differential diagnoses and formulate individualized treatment plans. Interventions include education about lifestyle modifications, the introduction and titration of cardiac medications, and referral for more advanced treatments such as vasoactive or inotropic medications, cardiovascular implantable electronic devices, and ventricular assist devices. Often, patients decide to discontinue these therapies. Standardized protocols for withdrawal of life-sustaining respiratory therapies provide structured guidance, reduce variation in practice, and improve satisfaction of families and healthcare providers. This chapter reviews such therapies and the process for cessation while simultaneously attending to symptom management.
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1919-, Zucker Marjorie B., and Zucker Howard D, eds. Medical futility and the evaluation of life-sustaining interventions. Cambridge: Cambridge University Press, 1997.
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Olson, Lori, and Christian T. Sinclair. A Communication Intervention in the Intensive Care Unit (DRAFT). Edited by Nathan A. Gray and Thomas W. LeBlanc. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190658618.003.0038.
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Caregiver outcomes of anxiety, depression, and posttaumatic stress disorder are modifiable based on care received while a patient is in the intensive care unit (ICU) setting. When compared to usual ICU care (which did include family meetings), the intervention added a structured end-of-life conference according to VALUE-based guidelines and a 15-page bereavement informational booklet. Patients in the intervention arm also had longer conferences, more time with family speaking, and more life-sustaining treatments withdrawn. The chapter describes the basics of the study, briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.
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Elective withdrawal of life-sustaining treatments in neonatal intensive care: Ethical implications. Ottawa: National Library of Canada, 1993.
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Rady, Mohamed Y., and Ari R. Joffe. Non-heart-beating organ donation. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0390.
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The transplantation community endorses controlled and uncontrolled non-heart-beating organ donation (NHBD) to increase the supply of transplantable organs at end of life. Cardiac arrest must occur within 1–2 hours after the withdrawal of life-support in controlled NHBD. Uncontrolled NHBD is performed after failed cardiopulmonary resuscitation in an unexpected witnessed cardiac arrest. Donor management aims to protect transplantable organs against warm ischaemic injury through the optimization of haemodynamics and mechanical ventilation. This also requires antemortem instrumentation and systemic anticoagulation for organ perseveration in controlled NHBD. Interval support with extracorporeal membrane oxygenation or cardiopulmonary bypass is generally required for optimal organ perfusion and oxygenation in uncontrolled NHBD, which remains a controversial medical practice. There are several unresolved ethical challenges. The circulatory criterion of 2–10 minutes of absent arterial pulse does not comply with the uniform determination of death criterion of the irreversible cessation of functions of the cardiovascular or central nervous systems. There are no robust safeguards in clinical practice that can prevent faulty prognostication, and premature withdrawal of treatment or termination of cardiopulmonary resuscitation. Unmanaged conflicting interests of increasing the supply of transplantable organs can have serious consequences on the medical care of potentially salvageable patients. Perimortem interventions can interfere with the delivery of an optimal quality of end-of-life care. The lack of disclosure of these NHBD ethical controversies does not uphold the moral obligation for an informed consent.
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Wagner, Beth. Withdrawal of Respiratory Technology. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190204709.003.0012.
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Respiratory failure can be defined as the inability of the lungs to provide adequate oxygenation or ventilation to sustain life. Respiratory failure can lead to abrupt clinical deterioration and is extremely distressing for patients and families. Advances in technology over the past decade have produced many life-sustaining therapies for patients with respiratory failure. Examples include high-flow oxygen therapy, invasive and noninvasive mechanically assisted breathing ventilation, prostacyclin therapy, and extracorporeal membrane oxygenation (ECMO). The care of these complex patients necessitates policies and procedures to assure quality care in withdrawal. Standardized protocols for withdrawal of life-sustaining respiratory therapies provide structured guidance, reduce variation in practice, and improve family and healthcare provider satisfaction.
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Wise, Matt, and Paul Frost. Terminal care in the intensive care unit. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0153.
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In the UK, around 10%–20% of all patients admitted to the intensive care unit (ICU) do not survive while, in the United States, it has been estimated that 22% of all deaths occur in an ICU. Therefore, terminal or palliative care is as important as any of the life-saving interventions that occur in the ICU. The goal of palliative care is to achieve a good death. In the ICU, the switch from care with curative intent to palliation occurs when it becomes obvious that the patient is not responding to treatment. Typically, this is manifest by deteriorating physiology and escalating organ support in the setting of overwhelming disease or injury. It is predominantly expert opinion (consensus amongst treating medical and nursing teams) that determines the point at which the patient is recognized as not responding to treatment and, in fact, dying. This chapter covers the ethical considerations, communication, family disagreement, organ donation, withdrawal of therapies, care after death, and diagnosing death.
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Sullivan, Maria A., and Frances R. Levin. Introduction. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199392063.003.0001.
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Alcohol and substance-use disorders in late life have been under-studied. Alcohol and prescription drugs are frequently abused by older Americans, yet addictive disorders are often difficult to identify in this population because of screening instruments adapted to younger adults, stigma and shame that limit help-seeking in older adults, and co-occurring medical and psychiatric conditions that mimic or mask both acute effects and withdrawal syndromes associated with alcohol or substance-use disorders. We will review the evidence for the effectiveness of motivational brief interventions in this population, the need to modify certain pharmacotherapies, including standard detoxification regimens, as well as how to develop age-specific treatment services which tailor the content and pace of presentation toward older adults. Older patients can demonstrate equally or more successful outcomes than younger individuals. This text is intended as a practical handbook to enhance clinical skills in identifying and treating addiction in older adults.
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Wakeman, Sarah E., and Josiah D. Rich. Pharmacotherapy for substance use disorders within correctional facilities. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199360574.003.0046.
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Drug addiction treatment is increasingly complex. Only 5% of prisons and 34% of jails offer any detoxification services, and only 1% of jails offer methadone for opioid withdrawal. Even fewer facilities offer medication assisted therapy (MAT) for alcohol or substance use disorders despite the tremendous evidence base supporting the use of medications to treat addiction. Untreated opioid dependence both within corrections and in the community is associated with HIV, Hepatitis C, crime, and death by overdose. Substantial evidence argues that these risks are reduced through long-term treatment with agonist medications such as methadone and buprenorphine. Only a minority of prisoners receive any addiction treatment while incarcerated. Those that do are usually offered behavioral interventions, which when used alone have extremely poor outcomes. Although there are limited studies on the outcomes of drug treatment during incarceration, there are nearly 50 years of evidence documenting the efficacy of methadone given in the community in reducing opioid use, drug-related health complications, overdose, death, criminal activity, and recidivism. Buprenorphine is similarly an effective, safe, and cost-effective long-term treatment for opioid dependence that reduces other opioid use and improves health and quality of life outcomes. There is a growing role for MAT in jails, and to a lesser degree in prisons for the treatment of alcohol and opiate dependence. This chapter presents the current state of evidence based practice in correctional MAT models.
Book chapters on the topic "Withdrawal of life-sustaining interventions"
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Risser, James M., and Howard Epstein. "Withdrawing Life-Sustaining Interventions." In Hospital-Based Palliative Medicine, 195–205. Hoboken, NJ: John Wiley & Sons, Inc, 2015. http://dx.doi.org/10.1002/9781118772607.ch14.
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Wright, Wendy L. "Ethical Issues and Withdrawal of Life-Sustaining Therapies." In Handbook of Neurocritical Care, 247–64. New York, NY: Springer New York, 2010. http://dx.doi.org/10.1007/978-1-4419-6842-5_14.
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Chase, Chere M., and Michael A. Williams. "Ethical Issues and Withdrawal of Life-Sustaining Therapies." In Handbook of Neurocritical Care, 311–24. Totowa, NJ: Humana Press, 2004. http://dx.doi.org/10.1007/978-1-59259-772-7_23.
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Backlund, E. O. "Death With Dignity — On the Withdrawal of Life-Sustaining Measures." In Neurosurgery and Medical Ethics, 71–74. Vienna: Springer Vienna, 1999. http://dx.doi.org/10.1007/978-3-7091-6387-0_15.
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Schears, Raquel M., and Terri A. Schmidt. "Revisiting Comfort-Directed Therapies: Death and Dying in the Emergency Department, Including Withholding and Withdrawal of Life-Sustaining Treatment." In Ethical Problems in Emergency Medicine, 99–115. Chichester, UK: John Wiley & Sons, Ltd, 2012. http://dx.doi.org/10.1002/9781118292150.ch10.
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Campbell, Margaret L., and Linda M. Gorman. "Withdrawal of Life-Sustaining Therapies." In Care of the Imminently Dying, 75–88. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780190244286.003.0005.
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Campbell, Margaret L., and Linda M. Gorman. "Withdrawal of life-sustaining therapies." In Oxford Textbook of Palliative Nursing, 463–72. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199332342.003.0028.
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Withdrawal of mechanical ventilation (MV), discontinuation of dialysis, and deactivation of cardiac devices are procedures that occur with relative frequency. The benefits of these therapies, when initiated, are to replace failing organs, extend life, and improve quality of life by relieving symptom distress associated with organ failure. When the burdens exceed the benefits, or when the patient is near death or unresponsive, decisions may be made to cease these therapies. In some cases, such as implantable cardioverter defibrillator (ICD) deactivation, no distress is anticipated. In others, such as discontinuing dialysis or withdrawing MV, measures to palliate anticipated distress must be applied. A peaceful death after cessation of life-prolonging therapies can be provided.
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"Withholding and Withdrawal of Life-Sustaining Therapy." In Encyclopedia of Trauma Care, 1800. Berlin, Heidelberg: Springer Berlin Heidelberg, 2015. http://dx.doi.org/10.1007/978-3-642-29613-0_101703.
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LINEBARGER, JENNIFER S., and MEGHAN TRACEWSKI. "Compassionate Extubation and Withdrawal of Life-Sustaining Therapies." In Handbook of Perinatal and Neonatal Palliative Care. New York, NY: Springer Publishing Company, 2019. http://dx.doi.org/10.1891/9780826138422.0019.
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Adil, M. M., and D. Larriviere. "Family discussions on life-sustaining interventions in neurocritical care." In Critical Care Neurology Part I, 397–408. Elsevier, 2017. http://dx.doi.org/10.1016/b978-0-444-63600-3.00022-2.
Full textConference papers on the topic "Withdrawal of life-sustaining interventions"
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Howes, Catherine. "029 Facilitating withdrawal of life-sustaining therapies outside the paediatric intensive care unit – a guideline for practice." In Great Ormond Street Hospital Conference 2018: Continuous Care. BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health, 2018. http://dx.doi.org/10.1136/goshabs.29.
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Greenberg, J. A., T. V. Quinn, J. Gerhart, and R. C. Shah. "Associations Between Prognostic Estimates and Decisions Regarding Life-Sustaining Interventions Among Surrogates and Physicians of Mechanically Ventilated Patients." In American Thoracic Society 2019 International Conference, May 17-22, 2019 - Dallas, TX. American Thoracic Society, 2019. http://dx.doi.org/10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a4159.
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