The following is about a commentary by Robert C McDermid and Sean M Bagshaw of in their article "Prolonging life and delaying death: The role of physicians in the context of limited intensive care resources. Philosophy, Ethics, and Humanities in Medicine 2009, 4:3." Full-text open access here). Which of the following point is not raised or quoted in the article?
A. In critical care, decisions regarding which patients may meaningfully benefit from advanced life support are a daily challenge. The majority of Canadian families do not want the opportunity for discussion and input into these important decisions, and most feel that the physician has an equal or greater role than the family in end-of-life decision-making.
B. Survivors of critical illness commonly state they would accept further ICU therapy should it be necessary, indicating that ICU care is perhaps not as unpleasant as either health care professionals believe or patients recall.
C. Gerontologists have recently defined the notion of "frailty" as a multidimensional syndrome characterized by the loss of reserve, where deficits accumulate that individually are reversible but collectively often represent an insurmountable burden of disease. Pragmatically, the authors suggested discussions regarding ICU triage and end-of-life care should initially focus on goals of therapy, incorporating an assessment of frailty, rather than on specific treatments (such as cardiopulmonary resuscitation) or on the futility thereof.
D. A systematic review by Sinuff et al demonstrated that acuity of illness on admission and discharge was higher during periods of bed shortage, and that patients denied access to ICU had a three-fold increase in mortality when compared to those admitted. It was also found that despite shorter lengths of ICU stay and higher acuity of illness on admission and discharge from ICU during periods of bed shortages, ICU mortality and readmission rates did not change.
Answer: A
The correct sentence as quoted in the article should be, "In critical care, decisions regarding which patients may meaningfully benefit from advanced life support are a daily challenge. The majority of Canadian families want the opportunity for discussion and input into these important decisions, but most feel that the physician has an equal or greater role than the family in end-of-life decision-making".
Abstract
Critical care is in an emerging crisis of conflict between what individuals expect and the economic burden society and government are prepared to provide. The goal of critical care support is to prevent suffering and premature death by intensive therapy of reversible illnesses within a reasonable timeframe. Recently, it has become apparent that early support in an intensive care environment can improve patient outcomes. However, life support technology has advanced, allowing physicians to prolong life (and postpone death) in circumstances that were not possible in the recent past. This has been recognized by not only the medical community, but also by society at large. One corollary may be that expectations for recovery from critical illness have also become extremely high. In addition, greater numbers of patients are dying in intensive care units after having receiving prolonged durations of life-sustaining therapy. Herein lies the emerging crisis – critical care therapy must be available in a timely fashion for those who require it urgently, yet its provision is largely dependent on a finite availability of both capital and human resources. Physicians are often placed in a troubling conflict of interest by pressures to use health resources prudently while also promoting the equitable and timely access to critical care therapy. In this commentary, these issues are broadly discussed from the perspective of the individual clinician as well as that of society as a whole. The intent is to generate dialogue on the dynamic between individual clinicians navigating the complexities of how and when to use critical care support in the context of end-of-life issues, the increasing demands placed on finite critical care capacity, and the reasonable expectations of society.