End-of-life decisions during intensive care treatment.
OBJECTIVE
End-of-life decisions play an important role in the intensive care unit. This review discusses the most important studies on end-of-life decisions published from October 2001 to October 2002.


RESULTS
Refusal of admission to the intensive care unit in itself is frequently an end-of-life decision. However, some patients survive rejection. The main end-of-life decisions during intensive care unit stay are withholding or withdrawal of therapy. Some patients have do-not-resuscitate orders on admittance to a unit. The effect of family participation and involvement of other caregivers in such decisions has been extensively studied. Such participation can lead to anxiety and depression in the family. A procedural guideline for decision making is of clinical interest. The background of physicians plays an important role. Terminal sedation and analgesia play an important role in execution of end-of-life decisions. During intensive care unit admission there is a continuous change in circumstances, which causes continuous differences in the wishes of the patients and relatives. The small contribution of the cost of the last days of life to total healthcare cost was reconfirmed.


CONCLUSIONS
The new studies put emphasis on the facts that all care providers should participate in the decision and that communication with surrogates is of extreme importance. Many valid points from other medical fields also apply to the intensive care unit situation.
Booij
Leo H D J
LH
Department of Anaesthesiology, University Medical Centre Nijmegen, The Netherlands. l.booij@anes.umcn.nl