Article Figures & Data
Figures
- Figure 1.
Pathways to life-sustaining treatment by default.
LST = life-sustaining treatment.
Tables
- Table 1.
Five Scenarios of Patients’ Preferred Style of Delegating Decision-Making Authority
Scenario and Patient Descriptive Comment ICU=intensive care unit. Note: The scenarios are labeled A through E to correspond to the focus-group–derived quotes A through E in Figure 1. Scenario A: A 61-year-old patient with stage 4 lung cancer, separated from his wife for more than 10 years “This is my own business and not for anyone else to meddle with. You get me the paperwork and I will write it down today—I don’t want anyone to put me on a breathing machine ever again.” Scenario B: A 73-year-old patient with advanced chronic obstructive pulmonary disease “It’s all right here, I wrote it all down and crossed all t’s. I don’t want to make it so hard on my kids like it was for me with my mom. They all have a copy of it and know exactly what I want.” Scenario C: An 80-year-old patient with colon cancer “My daughters all know what to do, and I know they will make good choices. I don’t need to waste ink on this, but we have talked a lot about my cancer, and I told them ‘Don’t let me linger.’” Scenario D: An 85-year-old patient with end-stage heart failure ”We have been married for over 60 years, I trust my wife completely to do the right thing when things get bad. I don’t have to tell her what to do.” Scenario E: A 58-year-old patient with stage 4 lung cancer who is undergoing palliative radiation At the beginning of a discussion to address code status he states: “I don’t want to talk about resuscitation. I don’t even want to think about those things. You better stop talking about this stuff.” When gently prodded about his experience with hospitals and ICUs, he mentions a friend who died “as a vegetable—you know, he was with a machine for breathing and couldn’t do anything for himself, and he was like that for over 6 months. He was in horrible shape.”
The Article in Brief
Preventing Life-Sustaining Treatment by Default
Ursula K. Braun , and colleagues
Background Many patients receive life-sustaining treatment by default, because there are no instructions available as to what kind of care the patient prefers and because surrogate decision makers are likely to ask for �everything� when they do not know a patient�s preferences. This article identifies pathways to life-sustaining treatment by default originating with the patient�s preferred decision-making style.
What This Study Found Preventing life-sustaining treatment by default depends on increasing the frequency with which patients make clear decisions or clearly express their values and goals and then effectively communicate this information to physicians and/or surrogates.
Implications
- Preventing life-sustaining treatment by default could enable family members to report the patient�s end-of-life preferences, rather than act as surrogate decision makers, and thus reduce the burdens of making end-of-life decisions without adequate information.
- Preventing life-sustaining treatment by default would help health care professionals to better respect patients' autonomy.
