What to Do When a Competent ICU Patient Does Not Want to Live Anymore but Is Dependent on Life-Sustaining Treatment? Experience From the Netherlands
van der Hoven, Ben
de Groot, Yorick J
Thijsse, Wilhelmina J
Kompanje, Erwin J O
Intensive care medicine 2010 Dec; 36(12): 2145-8
If patients on the intensive care unit (ICU) are awake and life-sustaining treatment is suspended because of the patients' request, because of recovering from the disease, or because independence from organ function supportive or replacement therapy outside the ICU can no longer be achieved, these patients can suffer before they inevitably die. In The Netherlands, two scenarios are possible for these patients: (1) deep palliative (terminal) sedation through ongoing administration of barbiturates or benzodiazepines before withdrawal of treatment, or (2) deliberate termination of life (euthanasia) before termination of treatment. In this article we describe two awake patients who asked for withdrawal of life-sustaining measures, but who were dependent on mechanical ventilation. We discuss the doctrine of double effect in relation to palliative sedation on the ICU. Administration of sedatives and analgesics before withdrawal of treatment is seen as normal palliative care. We conclude that the doctrine of the double effect is not applicable in this situation, and mentioning it criminalised the practice unnecessarily and wrongfully.
Showing items related by title, author, creator and subject.
"I Want to Live, Until I Don't Want to Live Anymore": Involving Children With Life-Threatening and Life-Shortening Illnesses in Decision Making About Care and Treatment Bluebond-Langner, Myra; Belasco, Jean Bello; DeMesquita Wander, Marla (2010-09)Pediatric societies in North America and in the United Kingdom and Europe take the position that children should be part of the decision-making process. Less clear, however, is how that should be accomplished. This article ...