Ethics and End-of-life Care

摘要: Because of the severity illness patients in intensive care unit (ICU), ICU is a setting where death common. Approximately 20% all deaths U.S. occur [1]. Although this proportion varies greatly different countries, relatively common most ICUs because these patients. Optimal palliative outpatients and acute long-term settings judicious use for those with terminal or life-limiting may prevent many admissions. Nonetheless, will likely remain an important endof-life both critically ill chronic, diseases their families opt trial if there reasonable chance that have extension life quality [2]. This chapter addresses ethical issues challenges arise providing high to who ultimately die ICU. Several studies documented shortcomings end-of-life For example, one study six hospitals US showed moderate severe pain [3], physicians are unaware patients’ preferences regarding [4] receive often not consistent treatment [3]. Another demonstrated signifi cant burden symptoms among cancer [5]. Studies from Europe show clinicians frequently do communicate adequately family members [6–8]. reasons, improving imperative. Perhaps best ways improve clarify goals advance critical avoid altogether when ICU-based life-sustaining therapies unwanted unlikely provide benefi t. In 1980s, experts believed directives would allow inform about they want at end technologic [9, 10]. Unfortunately, cantly affected aggressiveness costs [11, 12] nor changed decisionmaking [13, 14]. planning prior hospitalization be component [15]. However, even excellent communication, improved prognostication, Ethics End-of-life Care