Caring for patients and families at the end of life: withdrawal of intensive care in the patient's home.
OBJECTIVE
To describe our experience of transporting 17 intensive care patients home to die.


METHODS
A brief report.


METHODS
Mixed medical/surgical intensive care unit (ICU).


RESULTS
After discussions with their families, 17 adult patients in whom ongoing care was deemed either inappropriate or futile were transported home. Once there, intensive care modalities of ventilation and vasopressor therapy were withdrawn. The patients were sedated initially with intravenous morphine and if death was not immediately imminent, subcutaneous morphine was administered. In these cases where death took longer than 2 hours, the patients were managed with the assistance of district nurses, the family general practitioner, or staff from the South Auckland Hospice.


CONCLUSIONS
All the patients in this report were Maori or Polynesian and all families reported this as a positive experience. Since completion of this report, we have taken our first European patient home to die.
Clinical Charge Nurse, Department of Intensive Care Medicine, Middlemore Hospital, Auckland, New Zealand. smann@middlemore.co.nz
Sue
S
Mann
David
D
Galler
Pamela
P
Williams
Paul
P
Frost
D000328:Adult; D000368:Aged; D002423:Cause of Death / Q000639:trends; D016638:Critical Illness; D003657:Decision Making; D005066:Euthanasia, Passive; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data; D017051:Hospice Care; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011368:Professional-Family Relations; D016414:Resuscitation Orders; D013727:Terminal Care / Q000706:statistics & numerical data; D019452:Terminally Ill / Q000706:statistics & numerical data*; D014187:Transportation of Patients; D028761:Withholding Treatment