The Durban World Congress Ethics Round Table Conference Report: II. Withholding or withdrawing of treatment in elderly patients admitted to the intensive care unit

Bertrand Guidet; Eric Hodgson; Charles Feldman; Fathima Paruk; Jeffrey Lipman; Younsuck Koh; Jean Louis Vincent; Elie Azoulay; Charles L Sprung

doi:10.1016/j.jcrc.2014.08.004

The Durban World Congress Ethics Round Table Conference Report: II. Withholding or withdrawing of treatment in elderly patients admitted to the intensive care unit

J Crit Care. 2014 Dec;29(6):896-901. doi: 10.1016/j.jcrc.2014.08.004. Epub 2014 Aug 10.

Authors

Bertrand Guidet¹, Eric Hodgson², Charles Feldman³, Fathima Paruk⁴, Jeffrey Lipman⁵, Younsuck Koh⁶, Jean Louis Vincent⁷, Elie Azoulay⁸, Charles L Sprung⁹

Affiliations

¹ Assistance Publique, Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Paris, F-75012, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France. Electronic address: [email protected].
² Department of Anaesthesia & Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, eThekwini-Durban, South Africa.
³ Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁴ Department of Anaesthesiology, University of the Witwatersrand, Johannesburg, South Africa.
⁵ Department of Anaesthesiology and Critical Care, The University of Queensland School of Medicine: Department of Intensive Care Medicine l Royal Brisbane and Women's Hospital, Herston, QLD 4029.
⁶ Department of Pulmonary and Critical Care Medicine, Asan Medical Center, Univ. of Ulsan College of Medicine, 388-1 Pungnap Dong Songpa Ku, Seoul, 138-736, Korea.
⁷ Dept of Intensive Care, Université Libre de Bruxelles, Erasme Univ Hospital.
⁸ AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine, 1 avenue Claude Vellefaux, 75010 Paris, France.
⁹ General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, PO Box 12000, Jerusalem, Israel 91120.

PMID: 25216948
DOI: 10.1016/j.jcrc.2014.08.004

Abstract

Introduction: Life-sustaining treatment (LST) limitation for elderly patients is highly controversial. In that context, it is useful to evaluate the attitudes to LST in the elderly among experienced intensive care unit (ICU) physicians with different backgrounds and cultures.

Methods: A panel of 22 international ICU physicians from 13 countries responded to a questionnaire related to withholding (WH) and withdrawing (WD) LST in elderly patients using a semi-Likert scale.

Results: Most experts disagree or strongly disagree (77%) that age should be used as the sole criterion for WH or WD LST, and almost all disagree (91%) that there should be a specific age for such decision making. However, the vast majority (91%) acknowledge that age should be an important consideration in conjunction with other factors. Disagreement for consideration of prioritizing the young over the old in normal ICU operations was reported in 68%, whereas in an emergency triage situation, disagreement dropped to 18%.

Conclusions: There is a consensus among ICU physicians that age cannot be the sole criterion on which health care decisions should be made. In that perspective, it is important to provide data showing that outcome differences between elderly and nonelderly patients are partly related to decisions to forgo LSTs.

Keywords: Elderly; Ethics; Intensive care; Life-sustaining treatment.

MeSH terms

Advance Directives
Age Factors*
Aged
Attitude of Health Personnel*
Congresses as Topic
Critical Care / ethics*
Decision Making / ethics*
Female
Hospitalization
Humans
Intensive Care Units
Life Support Care / ethics
Male
Surveys and Questionnaires
Terminal Care
Triage
Withholding Treatment / ethics*