Evaluating our end-of-life practice.docVIP

Critical Care August 2001 Vol 5 No 4 Levy Commentary Evaluating our end-of-life practice Mitchell M Levy Rhode Island Hospital, Providence, Rhode Island, USA Correspondence: Mitchell M Levy, Mitchell_Levy@ Published online: 13 July 2001 Critical Care 2001, 5:182–183 ? 2001 BioMed Central Ltd (Print ISSN 1364-8535; Online ISSN 1466-609X) Abstract Ferrand et al’s recent study of witholding and withdrawing life support in intensive care units in France reminds us that reporting end-of-life practices is an important step towards enhancing end-of-life care. The study highlights differences between the parentalistic approach to decision making in Europe, and the patient autonomy model in the USA. However, the reasons intensivists report for witholding or withdrawing life support are similar in both cultures. Intensivists in France make decisions despite a lack of formal guidelines in their country. This study should serve as a stimulus for educating the public and motivating more groups to monitor their end-of-life practices. Keywords death, decision making, education, France, life support care End-of-life care for intensive care unit (ICU) patients in the USA has been well described, but only recently have reports been published describing this care in Europe [1–3]. In both cultures, however, the public and physi- cians have begun to pay more attention to the way in which death is handled in the ICU. Without question, end-of-life care in the ICU is undergoing radical transfor- mation. In order to effect any change, however, we need to look at what our practices are, what influences our decisions, and how this affects our care for patients who are dying in the ICU. cation with families, such as light-hearted quips, or quick, one-line expressions of sympathy. Consequently, families often feel abandoned by ICU care givers as their loved ones deteriorate and a