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dc.creatorWhite, Douglas B.en
dc.creatorCurtis, J. Randallen
dc.creatorWolf, Leslie E.en
dc.creatorPrendergast, Thomas J.en
dc.creatorTaichman, Darren B.en
dc.creatorKuniyoshi, Garyen
dc.creatorAcerra, Franken
dc.creatorLo, Bernarden
dc.creatorLuce, John M.en
dc.date.accessioned2016-01-08T23:20:40Zen
dc.date.available2016-01-08T23:20:40Zen
dc.date.created2007-07-03en
dc.date.issued2007-07-03en
dc.identifierdoi:10.7326/0003-4819-147-1-200707030-00006en
dc.identifier.bibliographicCitationAnnals of Internal Medicine 2007 July 3; 147(1): 34-40en
dc.identifier.urihttp://worldcatlibraries.org/registry/gateway?version=1.0&url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&atitle=Life+support+for+patients+without+a+surrogate+decision+maker:+who+decides?&title=Annals+of+Internal+Medicine+&volume=147&issue=1&date=2007-07&au=White,+Douglas+B.;+Curtis,+J.+Randall;+Wolf,+Leslie+E.;+Prendergast,+Thomas+J.;+Taichman,+Darren+B.;+Kuniyoshi,+Gary;+Acerra,+Frank;+Lo,+Bernard;+Luce,+John+M.en
dc.identifier.urihttp://dx.doi.org/10.7326/0003-4819-147-1-200707030-00006en
dc.identifier.urihttp://hdl.handle.net/10822/963453en
dc.description.abstractBackground: Physicians in intensive care units have withdrawn life support in incapacitated patients who lack surrogate decision makers and advance directives, yet little is known about how often this occurs or under what circumstances. Objective: To determine the proportion of deaths in intensive care units that occur in patients who lack decision-making capacity and a surrogate and the process that physicians use to make these decisions. Design: Multicenter, prospective cohort study. Setting: Intensive care units of 7 medical centers in 2004 to 2005. Patients: 3011 consecutive critically ill adults. Measurements: Attending physicians completed a questionnaire about the decision-making process for each incapacitated patient without a surrogate or advance directive for whom they considered limiting life support. Results: Overall, 5.5% (25 of 451 patients) of deaths in intensive care units occurred in incapacitated patients who lacked a surrogate decision maker and an advance directive. This percentage ranged from 0% to 27% across the 7 centers. Physicians considered limiting life support in 37 such patients or would have considered it if a surrogate had been available. In 6 patients, there was prospective hospital review of the decision, and in 1 patient, there was court review. In the remaining 30 patients, the decision was made by the intensive care unit team alone or by the intensive care unit team plus another attending physician. The authors found wide variability in hospital policies, professional society guidelines, and state laws regarding who should make life-support decisions for this patient population. Thirty-six of 37 life-support decisions were made in a manner inconsistent with American College of Physicians guidelines for judicial review. Limitations: The results are based on physicians' self-reported practices and may not match actual practices. The number of incapacitated patients without surrogates in the study is small. Conclusions: Incapacitated patients without surrogates accounted for approximately 1 in 20 deaths in intensive care units. Most life-support decisions were made by physicians without institutional or judicial review.en
dc.formatArticleen
dc.languageenen
dc.sourceeweb:308306en
dc.subjectAdultsen
dc.subjectAdvance Directivesen
dc.subjectCritically Illen
dc.subjectGuidelinesen
dc.subjectHospital Policiesen
dc.subjectIntensive Care Unitsen
dc.subjectLifeen
dc.subjectLawsen
dc.subjectPatientsen
dc.subjectPhysiciansen
dc.subjectReviewen
dc.subject.classificationProlongation of Life and Euthanasiaen
dc.subject.classificationThird Party Consenten
dc.titleLife Support for Patients Without a Surrogate Decision Maker: Who Decides?en
dc.provenanceCitation prepared by the Library and Information Services group of the Kennedy Institute of Ethics, Georgetown University for the ETHXWeb database.en
dc.provenanceCitation migrated from OpenText LiveLink Discovery Server database named EWEB hosted by the Bioethics Research Library to the DSpace collection EthxWeb hosted by DigitalGeorgetown.en


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