• Ned Tijdschr Geneeskd · Jan 2016

    Review Case Reports

    [Treatment in the Intensive Care Unit: continue or withdraw?].

    • Claudia Savelkoul, Nienke de Graeff, Erwin J O Kompanje, and Dave H T Tjan.
    • Ziekenhuis Gelderse Vallei, afd. Intensive Care, Ede.
    • Ned Tijdschr Geneeskd. 2016 Jan 1; 160: A9694.

    AbstractEnd-of-life decision-making in the Intensive Care Unit is a common and complex process. The step-by-step process of decision-making leading to withdrawal of life-sustaining treatment is illustrated in this paper by a clinical case. A variety of factors influences the decision to adjust the initial curative treatment policy towards withdrawal of life-sustaining therapy and the pursuit of comfort care. For a smooth decision-making process, it is necessary to make a prognosis and obtain consensus amongst the healthcare team. Withdrawal of life-sustaining treatment is ultimately a medical decision and a consensual decision should be reached by all medical staff and nurses, and preferably also by the patient and family. Timely involvement of a legal representative of the patient is essential for an uncomplicated decision-making process. Advance care planning and advance directives provide opportunities for patients to express their preferences beforehand. It is important to realise that end-of-life decisions are significantly influenced by personal and cultural values.

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