End of Life Working Party comment published in BMJ

7 December 2018

Dr Joe Cosgrove and Dr Chris Bassford, on behalf of the FICM End of Life Working Party, have written an open comment in the BMJ following on from a recent article “Intensive care: balancing risk and benefit to facilitate informed decisions” (BMJ: Gross, Fade, Brett). The commentary indicates what the Working Party are doing in this important area. Key points include:

 

  • Within the UK 15-20% of ICU admissions die in hospital.  There is therefore a duty for intensive care teams to provide effective care at the end of life when a patient is dying and treatments are ceasing to provide any physical or qualitative benefit for a patient (ICNARC-CMP).

  • Across Europe >80% of ICU patients who are close to death have lost capacity and are in no position to provide information to ICU teams about their beliefs and wishes (Ethicus-2 Study).

  • If ICU teams were better able to provide information to patients and the general public about benefits but also burdens of intensive care treatments there would be more opportunity for patients to understand what constituted realistic treatment in their individual circumstances.  

  • Through better understanding of shared decision making processes, we could enable advance care plans that reflect patients' own views, making it easier for intensive care teams to better provide care based on an individual's best interests and minimise misunderstandings and indeed conflict.