Journal of Critical Care
Volume 25, Issue 2 , Pages 360.e1-360.e8 , June 2010

Extubation versus tracheostomy in withdrawal of treatment—ethical, clinical, and legal perspectives

  • Sanjay Haresh Chotirmall, MB, MRCPI, MRCP(UK)

      Affiliations

    • Department of Medicine – Respiratory Research Division, Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin 9, Republic of Ireland
    • Corresponding Author InformationCorresponding author. Tel.: +353 1 8093764; fax: +353 1 8093765.
    • ,
  • Maura G. Flynn, BA, MLIS

      Affiliations

    • Department of Medicine – Respiratory Research Division, Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin 9, Republic of Ireland
    • ,
  • Ciaran F. Donegan, MB, FRCPI, FRCP (UK)

      Affiliations

    • Department of Medicine – Respiratory Research Division, Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin 9, Republic of Ireland
    • ,
  • David Smith, BPhil, BD, MA, STL, PhD

      Affiliations

    • Department of Medical Ethics, Royal College of Surgeons in Ireland, Dublin 2, Republic of Ireland
    • ,
  • Shane J. O'Neill, MB, FRCPI

      Affiliations

    • Department of Medicine – Respiratory Research Division, Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin 9, Republic of Ireland
    • ,
  • Noel Gerard McElvaney, MB, FRCPI, FRCPC

      Affiliations

    • Department of Medicine – Respiratory Research Division, Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin 9, Republic of Ireland

References 

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  14. Bernat JL. Medical futility: definition, determination, and disputes in critical care. Neurocrit Care. 2005;2:198–205
  15. Varelas PN, Abdelhak T, Hacein-Bey L. Withdrawal of life-sustaining therapies and brain death in the intensive care unit. Semin Neurol. 2008 Nov;28(5):726–735
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  18. Parker MH, Cartwright CM, Williams GM. Impact of specialty on attitudes of Australian medical practitioners to end-of-life decisions. Med J Aust. 2008 Apr 21;188(8):450–456
  19. Beauchamp TL, Childress JF. In: 5th ed.. Principles of biomedical ethics. New York: Oxford University Press; 2001;p. 57–272
  20. Losing the Wood for the trees: Burke and the Court of Appeal. Medical Law Review, 14, Summer 2006, p253–263. doi:10.1093/medlaw/fwl006. Advance Access Publication May 2, 2006. Published by Oxford University Press.
  21. General Medical Council, ‘Withholding and Withdrawing Life-Prolonging Treatments: Good Practice in Decision-Making’ (GMC 2002). United Kingdom.
  22. Mauri T, Pivi S, Bigatello LM. Prolonged mechanical ventilation after critical illness. Minerva Anestesiol. 2008;74(6):297–301
  23. Frick S, Uehlinger DE, Zuercher Zenklusen RM. Medical futility: predicting outcome of intensive care unit patients by nurses and doctors–a prospective comparative study. Crit Care Med. 2003;31:456–461
  24. Guidelines for the determination of death. Report of the medical consultants on the diagnosis of death to the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. JAMA. 1981;246:2184–2186
  25. Uniform Determination of Death Act. 12 Uniform Laws Annotated (U.L.A). 589 (West 1993 and West Supp 1997)
  26. Powner DJ, Hernandez M, Rives TE. Variability among hospital policies for determining brain death in adults. Crit Care Med. 2004;32:1284–1288
  27. Greer DM, Varelas PN, Haque S, Wijdicks EF. Variability of brain death determination guidelines in leading US neurologic institutions. Neurology. 2008;70:284–289
  28. Helms AK, Torbey MT, Hacein-Bey L, Chyba C, Varelas PN. Standardized protocols increase organ and tissue donation rates in the neurocritical care unit. Neurology. 2004;63:1955–1957
  29. Truog RD, Campbell ML, Curtis JR, et al. American Academy of Critical Care Medicine. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of Critical Care Medicine. Crit Care Med. 2008;36(3):953–963[Erratum in: Crit Care Med. 2008 May;36(5):1699]
  30. Campbell ML, Bizek KS, Thill M. Patient responses during rapid terminal weaning from mechanical ventilation: a prospective study. Crit Care Med. 1999;27:73–77
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  33. Withholding and Withdrawing Life-Prolonging Medical Treatment. Guidance for Decision-Making. British Medical Association. Blackwell Publishing – Third Edition. January 16 2007.
  34. Onwuteaka-Philipsen BD, Fisher S, Cartwright C, et al. European End-of-Life Consortium. End-of-life decision making in Europe and Australia: a physician survey. Arch Intern Med. 2006;166(8):921–929
  35. Schneiderman LJ, Gilmer T, Teetzel HD. Impact of ethics consultations in the intensive care setting: a randomized, controlled trial. Crit Care Med. 2000;28:3920–3924
  36. Way J, Back AL, Curtis JR. Withdrawing life support and resolution of conflict with families. BMJ. 2002;325(7376):1342–1345
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  39. Comhairle, 2005. Relate 32(11): 1-8. Accessed on 1, August 2008 at http://www.comhairle.ie/publications/relate/aug2005.pdf
  40. The Department of Justice, Equality and Law Reform, Ireland [homepage on the Internet]. Dublin, Ireland. [accessed June 10th 2009, cited 26th June 2009] Available from: http://www.justice.ie/en/JELR/Regulatory%20Impact%20Assessment.doc/Files/Regulatory%20Impact%20Assessment.doc

PII: S0883-9441(09)00231-7

doi: 10.1016/j.jcrc.2009.08.007

Journal of Critical Care
Volume 25, Issue 2 , Pages 360.e1-360.e8 , June 2010

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