The decisions we make - end of life on the ICU

Abstract

Intensive care physicians are frequently required to make treatment decisions on behalf of patients who lack capacity. In the UK, these decisions are taken under the ‘best interests’ principle, unless the patient has appointed a power of medical attorney or has a valid and relevant advanced directive. Although it is impossible to accurately predict the course of any one patient’s critical illness, there exists a plethora of data and scoring systems that can be applied to aid prognostication. In addition physicians have their own inherent beliefs and biases, based on experiential data that have been shown to be highly accurate1. Despite this potential for accurate outcome prediction, many incapacitated patients, with sequentially worsening prognoses, undergo prolonged periods of organ support without recovery. The absence of pre-morbid data of the patient’s own wishes makes decisions on the escalation of treatment particularly difficult. The aim of this study was to use a simulated scenario to explore differences in end-of-life decision-making between intensive care physicians and lay members of the public, as potential future patients.