Advance directives: Implications for critical care

  title={Advance directives: Implications for critical care},
  author={Henry J Silverman and J K Vinicky and M R Gasner},
  journal={Critical Care Medicine},
ObjectiveTo discuss the relative merits and limitations of living wills and the durable power of attorney for health care. Data SourcesComputerized search of MEDLINE. Study SelectionStudies involving treatment decisions at the end of life and descriptive articles on advance directives. ResultsThe recent Cruzan case and passage of the Patient Self-Determination Act have led to an ethical and legal recognition of advance directives, and therefore, critical care practitioners must be familiar with… Expand
Biomedical ethics and the withdrawal of advanced life support.
It is best to consider a situation futile when the patient is terminally ill, the condition is irreversible, and death is imminent, and a narrow definition of futility in this situation is the key. Expand
Advance directives in critically ill cancer patients.
The finding that advance directives were more common among Caucasians than other ethnic groups signifies the importance of considering cultural differences when addressing end-of-life issues with patients. Expand
Decisions to forego life-sustaining treatment and the duty of documentation
The medical records give a fairly accurate picture of the frequency with which decisions to forego life-sustaining treatment are made at this particular ICU, although the number might be somewhat underestimated. Expand
A history of ethics and law in the intensive care unit.
Major events in the history of ethics and law in the ICU are outlined, covering the evolution of ICUs, ethical principles, informed consent and the law, medical decision-making, cardiopulmonary resuscitation, withholding and withdrawing life-sustaining therapy, legal cases involving life support, advance directives, prognostication, and futility and the allocation of medical resources. Expand
Revering Individual Autonomy During Goals of Care Family Meetings
This commentary is intended to highlight the fundamental role of surrogates in extending the patient’s autonomy, and the importance of educating clinicians in training in the process of family meetings. Expand
End-of-Life Care in Geriatric Population
The review provides an overview of end-of-life care with highlights of the ethical issues pertaining to the elderly, including decision-making for those with and without capacity, the right to prepare advance directives prior to the occurrence of incompetency and theright to use or refuse life-sustaining technologies. Expand
Barriers to High Quality End of Life Care in the Surgical Intensive Care Unit
End of life discussions frequently take place in surgical intensive care units, as a significant number of patients die while admitted to the hospital, and surgery is common during the last month ofExpand
Advance directives in the medical intensive care unit of a community teaching hospital.
Advanced directives were infrequently available and had little impact on the pattern of care in a medical intensive care unit (MICU) setting before and 9 months after the implementation of the Patient Self-Determination Act (PSDA). Expand
The necessity of ethical support for health care professionals in Intensive Care: Role and competencies of the Clinical Ethics Committee
Promoting measures that aim to mitigate discrepancies in the decision-making process, ensuring adequate training of physicians in the ethical aspect of care, and incrementing the wellbeing ofExpand
An oncology patient's choice to forgo nonvolitional nutrition support: ethical considerations.
  • G. Chapman
  • Medicine
  • Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
  • 1996
This case illustrates the ethical considerations surrounding a patient's decision to forgo medical care that might prolong life and accepts an oral diet as tolerated in the care of his family and hospice. Expand