American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Feb 1995
Decisions to limit or continue life-sustaining treatment by critical care physicians in the United States: conflicts between physicians' practices and patients' wishes.
We surveyed a national sample of 879 physicians practicing in adult intensive care units in the United States, in order to determine their practices with regard to limiting life-sustaining medical treatment, and particularly their decisions to continue or forgo life support without the consent or against the wishes of patients or surrogates. Virtually all of the respondents (96%) have withheld and withdrawn life-sustaining medical treatment on the expectation of a patient's death, and most do so frequently in the course of a year. ⋯ We conclude that physicians do not reflexively accept requests by patients or surrogates to limit or continue life-sustaining treatment, but place these requests alongside a collection of other factors, including assessments of prognosis and perceptions of other ethical, legal, and policy guidelines. While debate continues about the ethical and legal foundations of medical futility, our results suggest that most critical care physicians are incorporating some concept of medical futility into decision making at the bedside.
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Am. J. Respir. Crit. Care Med. · Feb 1995
Blue-collar normative spirometric values for Caucasian and African-American men and women aged 18 to 65.
Normative spirometric values were derived from 5,042 white (of mainly European ancestry) and black (of mainly African ancestry) men and women paper plant workers who are never-smokers, with no respiratory symptoms or diagnoses and no history of occupational exposure to fibrogenic dusts or irritant chemicals. This cohort was selected from a much larger population under long-term respiratory surveillance (n > 50,000 at 50 plants). Standardized equipment, procedures, and data reduction methods complied with ATS recommendations. ⋯ The age range of the cohort, 18 to 65, provides a regression that more closely matches the observed values in this range, because it does not include "supernormal" elderly survivors, which can lessen the slope of the regression and artifactually increase the predicted values of 50 to 65 yr olds. The regression equations derived for black men and women do not support the use of a single race adjustment (0.85 or 0.88) for all age, sex, height, and spirometric test parameter combinations. These race- and gender-specific regression equations, with their respective lower limits of normal, should improve the detection and quantification of adverse health effects in working individuals and populations.