title: The withdrawal of life support in adult intensive care: an evaluative review of the literature.
abstract: To ensure that intensive care is both cost-effective and humanitarian depends on a willingness to withdraw treatment once the prognosis is recognised as being hopeless, as the process of dying may be prolonged if futile treatment is continued Continuing advances in technology, science and professional care, raising new ethical, economic and legislative dilemmas, mean the decision to withdraw treatment in intensive care has become an issue of renewed concern These advances require both the development of scientific methods to support the decision-making process and an understanding of the ethical balance that underpins such decisions with particular reference to the intensive care nurse Whilst there is recognition that the families of patients who die in intensive care require ongoing support and bereavement care, there is little to suggest that the needs of the multidisciplinary personnel caring for these patients are understood or provided for This paper aims to explore quality end-of-life care, common medical practices, research into the role of the expert nurse in caring for the dying patient and new strategies for the incorporation of palliative care Strategies are proposed to translate the shared ownership, responsibility and accountability of clinical governance regarding these decisions into positive action, consensus and collaboration at both local and national level.
authors.affiliation: The Royal North Shore Hospital, Sydney, NSW, Australia. sydnerroad@talk21.com
authors.forename: Rebecca
authors.initials: R
authors.lastname: Stroud
mesh_terms: D000328:Adult; D003422:Critical Care / Q000458:organization & administration*; D003659:Decision Making, Organizational; D004992:Ethics, Medical; D005190:Family / Q000523:psychology; D006117:Grief; D006801:Humans; D018447:Medical Futility; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D015403:Nursing Evaluation Research; D010344:Patient Advocacy; D010348:Patient Care Team / Q000458:organization & administration; D028662:Principle-Based Ethics; D011788:Quality of Life; D012944:Social Support; D013727:Terminal Care / Q000458:organization & administration* / Q000523:psychology; D028761:Withholding Treatment