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dc.contributor.authorChotirmall, Sanjay Haresh
dc.contributor.authorFlynn, Maura G
dc.contributor.authorDonegan, Ciaran F
dc.contributor.authorSmith, David
dc.contributor.authorO'Neill, Shane J
dc.contributor.authorMcElvaney, Noel Gerard
dc.date.accessioned2011-04-05T14:50:54Z
dc.date.available2011-04-05T14:50:54Z
dc.date.issued2010-06
dc.identifier.citationExtubation versus tracheostomy in withdrawal of treatment-ethical, clinical, and legal perspectives. 2010, 25 (2):360.e1-8 J Crit Careen
dc.identifier.issn1557-8615
dc.identifier.pmid19850443
dc.identifier.doi10.1016/j.jcrc.2009.08.007
dc.identifier.urihttp://hdl.handle.net/10147/127210
dc.description.abstractThe provision of life-sustaining ventilation, such as tracheostomy to critically ill patients, is commonly performed. However, the utilization of tracheostomy or extubation after a withdrawal of treatment decision is debated. There is a dearth of practical information available to aid clinical decision making because withdrawal of treatment is a challenging scenario for all concerned. This is further complicated by medicolegal and ethical considerations. Care of the "hopelessly ill" patient should be based on daily evaluation and comfort making it impossible to fit into general algorithms. Although respect for autonomy is important in healthcare, it is limited for patients in an unconscious state. Beneficence remains the basis for withdrawing treatment in futile cases and underpins the "doctrine of double effect." This article presents a relevant clinical case of hypoxic brain injury where a question of withdrawal of treatment arose and examines the ethical, clinical, and medicolegal considerations inherent in such cases, including beneficence, nonmaleficence, and the "sanctity of life doctrine." In addition, the considerations of prognosis for recovery, patient autonomy, patient quality of life, and patient family involvement, which are central to decision making, are addressed. The varying legal frameworks that exist internationally regarding treatment withdrawal are also described. Good ethics needs sound facts, and despite the lack of legal foundation in several countries, withdrawal of treatment remains practiced, and the principles described within this article aim to aid clinician decision making during such complex and multifaceted end-of-life decisions.
dc.language.isoenen
dc.subject.meshAdult
dc.subject.meshBeneficence
dc.subject.meshCritical Care
dc.subject.meshDecision Making
dc.subject.meshGreat Britain
dc.subject.meshHumans
dc.subject.meshHypoxia, Brain
dc.subject.meshIntubation, Intratracheal
dc.subject.meshMale
dc.subject.meshPersonal Autonomy
dc.subject.meshProfessional-Family Relations
dc.subject.meshPrognosis
dc.subject.meshQuality of Life
dc.subject.meshTracheostomy
dc.subject.meshValue of Life
dc.subject.meshWithholding Treatment
dc.titleExtubation versus tracheostomy in withdrawal of treatment-ethical, clinical, and legal perspectives.en
dc.typeArticleen
dc.contributor.departmentDepartment of Medicine - Respiratory Research Division, Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin 9, Republic of Ireland. schotirmall@rcsi.ieen
dc.identifier.journalJournal of critical careen
dc.description.provinceLeinster
html.description.abstractThe provision of life-sustaining ventilation, such as tracheostomy to critically ill patients, is commonly performed. However, the utilization of tracheostomy or extubation after a withdrawal of treatment decision is debated. There is a dearth of practical information available to aid clinical decision making because withdrawal of treatment is a challenging scenario for all concerned. This is further complicated by medicolegal and ethical considerations. Care of the "hopelessly ill" patient should be based on daily evaluation and comfort making it impossible to fit into general algorithms. Although respect for autonomy is important in healthcare, it is limited for patients in an unconscious state. Beneficence remains the basis for withdrawing treatment in futile cases and underpins the "doctrine of double effect." This article presents a relevant clinical case of hypoxic brain injury where a question of withdrawal of treatment arose and examines the ethical, clinical, and medicolegal considerations inherent in such cases, including beneficence, nonmaleficence, and the "sanctity of life doctrine." In addition, the considerations of prognosis for recovery, patient autonomy, patient quality of life, and patient family involvement, which are central to decision making, are addressed. The varying legal frameworks that exist internationally regarding treatment withdrawal are also described. Good ethics needs sound facts, and despite the lack of legal foundation in several countries, withdrawal of treatment remains practiced, and the principles described within this article aim to aid clinician decision making during such complex and multifaceted end-of-life decisions.


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