Doing ‘everything’ near the end of life may be inappropriate for seniors in ICU

Magnolia Cardona, Ebony T. Lewis, Alex Psirides

Research output: Contribution to journalOnline ResourceProfessional

Abstract

No-one wants to be a patient in an intensive care unit (ICU). But if you ever do require intensive care, would you or your family like to be better informed about the harms and benefits of intensive treatment?
While clinicians are trained to save lives and cure disease, there is a point where 'if they can’t save their lives they should save their deaths'. Allowing a dignified death rather than prolonging the dying process could reduce unnecessary suffering as well as avoid giving families false hope and pathological grief. The
concept of ‘inappropriateness’, in a system where ‘everything’ is both provided by default, and is an expectation of both society and medical culture, needs to be recognised and discussed. Treatments that do not impact on survival time or improve quality of life are not in seniors’ best interests, often prevent the
achievement of a ‘good’ death and erode the sustainability of the health system. As one family member recently told an ICU clinician during a meeting to talk about realistic expectations for their loved one, “Sometimes, doctor, there are things worse than death.”
The often default process of ‘decisions made about me without me’ is only slowly changing. Empowering seniors and their families to challenge clinicians and ask about treatment burdens and realistic expectations, as well as encouraging open and honest conversation about dying, will only improve the care they receive.
Original languageEnglish
Number of pages2
JournalNursing Review
Publication statusPublished - 1 Oct 2019

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