withholding & withdrawing treatment

ktwlpn, LPN · May 2, 2003

Originally posted by Zana
Which health care members are involve in the decision making when it comes to withholding or withdrawing treatment within the ICU setting?

Who is the Senior member of the team who takes responsibility for the decision with rationale.

Isn't that up to the patient and the patient's s.o.? In my experience most docs are not good with end of life issues-it is often up to the bedside nurses to open the dialogue and encourage the family to question the docs....If you are talking about a code situation the doc running the code can call it...Maybe I don't get the question.......

altomga, ADN, BSN, MSN, DNP, RN, APRN · May 2, 2003

The family makes the final decision (unless it has been taken to court)..thankfully we have an end of life specialist that we can consult to speak with the family:):) Like it was said already..doctors do not particularly like approaching this subject, but seem to find it easier after the EOL person has already been in. The nurses have a lot to do with helping the family make this painful decision also.

Mainly though.....THANK GOODNESS FOR THE EOL..SHE'S EXCELLENT!!!!!!!!!!!!

gwenith, BSN, RN · May 2, 2003

Most commonly it is the Consultants who approach the family. The majority of ICU consultants I have worked with are very well aware of the cost - personal, familial, sociological and financial of keeping a patient in ICU. Most will speak to the relatives on a day by day basis and will approach and discuss issuses such as continuance of treatment when the outlook appears "grim:. How reluctant the consultant is to do this depends very much on thier own personal beliefs.

Except in the case of brain death where a legal criteria has been met for withdrawal of treatment the family is ALWAYS consulted and spoken to with regards to the patient's wishes.

In the case of a patient with multiple co-morbidities and/or underlying near teminal disorder we may do a "one way wean". This is where they are taken off the ventilator with the understanding that if they deteriorate again they will not be re-intubated. In these cases we usually try to have the patient in as "good" a condition as possible so that extubation is survivable.

The personal factors which influence how readily a medical officer will approach teh family and discuss termination of treatment include religious beliefs, life experience, and having come to terms with thier own mortality. (which sounds dramatic but there is no other way of describing it). Acceptance by other staff of the decision is not essential but I do not think that such an issue would be discussed if, say, the majority of nurses were vehemently against the decision.

The family have a "right of veto" in this instance. They can stop us at any time from withdrawing treatment. I have seen this go to extraordinary lengths where a patient was kept alive on a ventilator for 4 months slowly deteriorating. The day he died we could smell him 2 floors away and yet his sisters still screamed the unit down, sobbing uncontrollably demanding to know why we couldn't do more. Looking back on the incident and with the expereince I have now we should have had a trained psychologist in. This is the "trap" that can occur when the family has this veto - it can occur (fortunately rarely) where the shock and stress of immanent death of a loved one causes teh relative to lose contact with reality. I have seen relatives holding the hands of a brain dead patient saying "LOOK! LOOK! they are moving thier eyes/hands/feet!" It is one of the hardest jobs in nursing to have to say "No they are not moving"