title: [Treatment in the Intensive Care Unit: continue or withdraw?].
abstract: End-of-life decision-making in the Intensive Care Unit is a common and complex process. The step-by-step process of decision-making leading to withdrawal of life-sustaining treatment is illustrated in this paper by a clinical case. A variety of factors influences the decision to adjust the initial curative treatment policy towards withdrawal of life-sustaining therapy and the pursuit of comfort care. For a smooth decision-making process, it is necessary to make a prognosis and obtain consensus amongst the healthcare team. Withdrawal of life-sustaining treatment is ultimately a medical decision and a consensual decision should be reached by all medical staff and nurses, and preferably also by the patient and family. Timely involvement of a legal representative of the patient is essential for an uncomplicated decision-making process. Advance care planning and advance directives provide opportunities for patients to express their preferences beforehand. It is important to realise that end-of-life decisions are significantly influenced by personal and cultural values.
authors.affiliation: Ziekenhuis Gelderse Vallei, afd. Intensive Care, Ede.
authors.forename: Claudia
authors.initials: C
authors.lastname: Savelkoul
authors.forename: Nienke
authors.initials: N
authors.lastname: de Graeff
authors.forename: Erwin J O
authors.initials: EJ
authors.lastname: Kompanje
authors.forename: Dave H T
authors.initials: DH
authors.lastname: Tjan
mesh_terms: D032722:Advance Care Planning; D016223:Advance Directives; D003657:Decision Making; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011795:Surveys and Questionnaires