Withdrawal of life-sustaining therapy: the case for delay
| Autor: | Bernard A Foëx |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Neurological injury Time Factors media_common.quotation_subject Critical Care and Intensive Care Medicine Insult 03 medical and health sciences 0302 clinical medicine Utilitarianism medicine Humans 030212 general & internal medicine Justice (ethics) Psychiatry Intensive care medicine media_common business.industry Uncertainty Neurointensive care 030208 emergency & critical care medicine General Medicine Supreme court Withholding Treatment Brain Injuries Emergency Medicine Form of the Good business Ethical Theory Autonomy Brain Stem |
| Zdroj: | Emergency medicine journal : EMJ. 34(4) |
| ISSN: | 1472-0213 |
| Popis: | To everything there is a season …When should life-sustaining treatment (LST) be stopped? The simple answer is when it is no longer appropriate to continue. This may be when the patient withdraws consent for treatment to continue, or when further treatment becomes futile. But what is futility? “I know it when I see it”, as Supreme Court justice Potter Stewart said in 1964 (in relation to something quite different). In some cases it is indeed easy to recognise. A definition may be more challenging. A treatment may be said to be futile when it will not achieve its stated aim either qualitatively or quantitatively.1 An example of qualitative futility is giving antibiotics for a viral infection. Quantitative futility is, for example, giving ever-increasing doses of norepinephrine to a patient with multiorgan failure, who remains hypotensive and whose lactate is increasing. Quantitative futility has also been defined as a treatment, which has a less than 1 in a 100 chance of success.1 In the case discussed by Gardiner et al 2 in this journal (ref) there are several rationales for not stopping LST early, namely, 1. Prognostic uncertainty 2. Brainstem testing as a diagnostic end point 3. Respect for autonomy 4. Utilitarianism (maximising the good) Each of these deserves some explanation. It is difficult to make predictions, especially about the futurei The Neurocritical Care Society (NCS) has recommended defining a devastating brain injury (DBI) as, ‘neurological injury where there is an immediate threat to life from a neurological cause’, and, ‘severe neurological insult where early … |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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