1. 2.14
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2. Management of Surgical Emergencies Part 1 : Critical Care
End-of-Life Care in Critical Care
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3. How would you like to die?
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4. Define a bad death
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5. How do people die in hospital?
Good?
Bad?
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6. How can we improve the care of the dying patient?
Recognition of dying patient
Treatment limitation?
Treatment withdrawl?
Futility?
Palliation
Involve patient? / family? / doctors? / nurses?
Who decides
Not withdrawal of care but change in goals of care
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7. What can you do Relieve suffering!!! Stop curative therapies?
Painkillers, sedatives, fans
Stop curative therapies?
Dying wishes?
Help with patients unresolved issues?
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8. Good result Inevitability of dying process recognised
Patient dies peacefully
No suffering
Family happy that patient had a comfortable and dignified death
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9. When Should We Involve Families in Decisions about Life Support?
Not after the ICU team has decided it is time to withdraw life support
Discussions with ICU team should occur on ICU admission
Review prognosis and potential outcomes
Bring family along with us as things change
Discussion with other clinicians should occur prior to ICU admission
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10. VALUE: 5-step Approach to Improving Communication in ICU with Families
V… Value family statements
A… Acknowledge family emotions
L… Listen to the family
U… Understand patient as a person
E… Elicit family questions
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11. Tips for Talking with Family About Withdrawal of Life Support
When life support is withdrawn, stress
“Care” will not be withdrawn
Aggressive palliation will be used
avoid making firm predictions about the patient’s clinical course
Time to death variable
Offer option of family being present
Family presence may be associated with higher PTSD
Describe process so they know what to expect
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12. Cultural Differences Try to understand & respect cultural differences
Strike right balance in taking ethically right decisions and conforming with family wishes
Ensure that any decision taken is finally in the patient's benefit
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13. Needs of the Patient Receiving adequate pain and symptom management.
Avoiding inappropriate prolongation of dying
Achieving a sense of control
Strengthening relationships with loved ones.
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14. Questions?
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15. Summary: Ethical and Practical Issues in End-of-life Care on ITU
Withdrawal of life support is not just a clinical procedure
Decision-making about end-of-life care common in the ICU and should start early
Shared decision-making as default
Need to adapt to individual patient and family
Consider discussion of organ donation early if appropriate
Interdisciplinary communication essential
Incorporate and honour cultural differences
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