Abstract
Objective: To describe the nature and problems associated with end-of-life care (EOLC) in an intensive care unit. Design: Retrospective chart review study. Setting: Intensive care unit of an urban hospital's emergency and critical care medicine department. Patients: All patients who admitted to and expired in the ICU between April 2004 and March 2005. Measurements and main results: Sixty-one patients (male 36 : female 25) expired in the ICU, however, only five patients had indicated their wishes beforehand. Despite having been explained about the poor chance of recovery, the family desired aggressive treatment in 34 cases at first. However, in 47 cases, the families indicated their wish for “do not attempt resuscitation (DNAR)” in the end. The course of treatment for all the patients was decided after consultation between the doctor-in-charge and the patient's family. There were no cases with consulting ethical conference. After the decision for DNAR was conveyed in the ICU, some treatment options were withheld or withdrawn. Conclusions: Obviously, EOLC should be based on the needs in individual cases, however, in all cases, the decisions on EOLC should be made by a medical team or at the level of the institution. The following issues in relation to EOLC are in need of urgent debate. (1) How can a patient's treatment course be mapped out without a knowledge of the patient's own wishes. (2) How can it be determined that a patient cannot recover. (3) Treatment options within the ethical framework, after deciding on DNAR.
