Sujet(s)
Euthanasie active/législation et jurisprudence , Euthanasie passive/législation et jurisprudence , Suicide assisté/législation et jurisprudence , Adulte , Directives anticipées , Canada , Enfant , Homicide/législation et jurisprudence , Humains , Consentement libre et éclairé , Responsabilité légale , Capacité mentale , Mineurs , Motivation , Consentement parental , État végétatif persistant , Médecins , Mandataire , Droit à la mort/législation et jurisprudence , République d'Afrique du SudRÉSUMÉ
PURPOSE: To discuss the medical, ethical and legal basis of decisions to discontinue life-support therapy in the adult intensive care unit (ICU), and to provide practical guidelines for the discontinuation of life support therapy. SOURCE: Relevant articles were retrieved through Medline (1991-present; terms: ethics, life support discontinuation, double effect, beneficence, non-maleficence). Other sources include legal references, and personal files. PRINCIPAL FINDINGS: Understanding the legal and ethical principles of autonomy, beneficence, non-maleficence and double effect are crucial when withdrawing life support therapy. The law respects a competent patient's right to direct his/her healthcare but does not uphold his/her right to demand futile care. Surrogate decision makers can be used when the patient is incompetent, provided they are acting in the patient's best interest. Euthanasia is illegal and the distinction between discontinuation of therapy and euthanasia is legally clear. Skillful administration of palliative therapy cannot be construed as euthanasia when the aforementioned ethical principals are respected. The various practical methods of discontinuing therapy are discussed. Every ICU should develop its own guidelines and a checklist to help caregivers during this difficult time. Caregivers must anticipate the mechanism of death and direct interventions at the symptoms that are likely to cause discomfort. Drugs and dosages must be individualized, and depend on the underlying disease, anticipated mechanism of death, and the patient's pharmacological history. When prescribing a drug, the intention should be clear. CONCLUSIONS: Appropriate discontinuation of therapy in the ICU allows patients a dignified and comfortable death.
Sujet(s)
Déontologie médicale , Euthanasie passive , Unités de soins intensifs , Abstention thérapeutique , Désaccords et litiges , Principe du double effet , Éthique , Comités d'éthique clinique , Processus de groupe , Humains , IntentionSujet(s)
Autonomie professionnelle , Ordres de réanimation/législation et jurisprudence , Consentement d'un tiers/législation et jurisprudence , Maltraitance des enfants , Prise de décision , Homicide/législation et jurisprudence , Humains , Nourrisson , Soins de maintien des fonctions vitales/législation et jurisprudence , Manitoba , État végétatif persistantRÉSUMÉ
Results of chemotherapy with taxol (paclitaxel) in 55 patients with recurrent breast and ovarian cancer were reviewed. Taxol was given as a 3-hour infusion, every 3 weeks, on an outpatient basis. There was complete or partial response in 8 patients (23%) with breast cancer and 10 (50%) with ovarian cancer. Performance status and previous response to adriamycin were important prognostic factors. Toxicity was manageable. Treatment had to be stopped for hypersensitivity reactions in only 2 patients. Taxol given in an ambulatory clinic is safe and effective.
