During this session, several of the most frequently encountered ethical controversies in the ICU are presented.

• J. Randall Curtis, MD, MPH, examines the question, Who can best direct EOLC in the ICU: Intensivist or Palliative Care Specialist?
• Robert D. Truog, MD, FCCM, examines the question, Should a DNAR patient ever be admitted to the ICU?
• Cynda H. Rushton, RN, DNSC, examines the question, Should all DNR/DNI patients have an ethics/palliative care consult?
• Joel E. Frader, MD, compares autonomy vs parentalism in EOL decision making
• Mitchell M. Levy, MD, FCCM, examines the question, Is not offering therapies the same as withdrawal of support?

Watch Video Presentation

SCCM Statement on End-of-Life Decisions

Increased attention is directed to the complexities of end-of-life decision making and to the potentially tragic circumstances facing all critically ill or injured patients and their families. Like you, the Society's leadership follows these public debates intently. After considerable discussion, SCCM thought it best to refrain from issuing public statements related to current events, preferring to focus on how SCCM could assist critical care providers and their patients.

The Society affirms that end-of-life decisions are personal and are, therefore, best left to patients and their family members working in concert with their healthcare providers. Thus, all possible efforts should be made to keep these complex decisions out of the legal system. Please remember that ongoing open, verbal communication among patients, families, and the primary providers is vitally important in managing the issues related to end-of-life care.

The Society provides resources relevant to end-of-life decisions to assist critical care providers, patients, and their families during these difficult situations. We also encourage you to ensure your own wishes are adequately documented in the event you are not personally able to direct your own care. 

Guidelines

Recommendations for end-of-life care in the intensive care unit:  A consensus statement by the American Academy of Critical Care Medicine 2008

Clinical practice guidelines for support of the family in the patient-centered intensive care unit: 2004-2005

Journals

Society members were major participants in a Robert Wood Johnson Foundation research grant that focused on end-of-life care. The outcomes are published: Quality indicators for end-of-life care in the intensive care unit (Crit Care Med 2003; 31: 2255-2262). The complete article, with an accompanying editorial written by the 2005 SCCM President, is available on the SCCM Web site.

Challenges in end-of-life care in the ICU: statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003 included major contributions from SCCM members and was published in Critical Care Medicine: (Thompson BT, Cox PN, Antonelli M, et al executive summary. Crit Care Med. 2004; 32:1781-1784).  A copy is also available on the SCCM Web site. The full article was published in Intensive Care Medicine. 


Supplements


A special EOL supplement of Critical Care Medicine was published in November 2006.  See details on the publisher's site. 


Publications


The Society's American College of Critical Care Medicine (ACCM) previously published Recommendations for End-of-Life Care in the ICU, which is available on the SCCM Web site. The Society also published Consensus statement of the Society of Critical Care Medicine's Ethics Committee regarding futile or other possibly inadvisable treatments (Crit Care Med. 1997; 25: 887-891). 


The ACCM Ethics Committee has updated Critical Care Ethics: A Practice Guide, which includes several questions specific to EOL care and other material relevant to EOL ethics. The second edition is available from the SCCM online product catalog. A list of chapters is available here. 

 
Critical Connections Article

Palliative Medicine and Family Support in the ICU
December 2008, Critical Connections

DVDs


The Compassionate Care in the ICU DVD was sent to all SCCM members.  The professional version went to individual SCCM members, and the family version was sent to ICU directors.  If you need an additional copy of these DVDs please contact SCCM Headquarters at +1 (847) 827-6888.  Supplies are limited. Watch the Family Version of the online video presentation located on the right column.

Patient and Family Support


The society's ICU Issues and Answers brochure on "What Are My choices Regarding life support?" is available free online and also available in printed copy through the SCCM catalog and online store. Of note, additional online information for personal advanced care planning is available from the National Hospice and Palliative Care Organization (www.caringinfo.org).  

The Society's American college of Critical Care Medicine (ACCM) previously published Recommendations for End-of-Life Care in the ICU, which is available here.

The Society also has participated in the process to establish practice parameters on the Assessment and Management of Patients in the Persistent Vegetative State issued by the American Academy of Neurology.  A copy of these parameters, along with an ethics statement, is available online.

Organizational Information

The Hastings Center recently published Improving End-of-Life Care: Why Has It Been So Hard?  The full text can be downloaded from the Hastings Center Web site, or a print copy ordered from publications@hastingscenter.org. 

The Society also participated in the process to establish practice parameters on the Assessment and Management of Patients in the Persistent Vegetative State issued by the American Academy of Neurology (AAN).  A copy of these parameters is available from the AAN Web site.  

A statement from the December 2004 National Institutes of Health (NIH) State-of-the-Science conference on Improving End-of-Life Care, led by the National Institute of Nursing Research, is available from the NIH Web site. It includes a roster of participants.

Families inevitably experience turmoil when dealing with end-of-life decision making. The SCCM remains committed to ensuring patients receive the Right Care, Right Now - especially for those patients and families who unfortunately must manage the issues surrounding the end of life.

  SCCM Pod-115 PCCM: Difficult Conversations in the Pediatric ICU
Elaine Meyer, RN, PhD, discusses a paper published recently in Pediatric Critical Care Medicine, titled “Difficult Conversations: Improving Communication Skills and Relational Abilities in Healthcare.” Meyer, a clinical psychologist, is the Director of the Institute for Professionalism and Ethical Practice at Children’s Hospital Boston, Massachusetts. She also is Associate Professor of Psychology at Harvard Medical School.  (Pediatr Crit Care Med. 2009;10[3]:352-359) Released: 8/31/09

 SCCM Pod-114 CCM: Why Not Physician-Assisted Death
Constantine A. Manthous, MD, associate clinical professor of medicine at Bridgeport Hospital and Yale University School of Medicine in Connecticut, discusses his article published in the April 2009 issue of Critical Care Medicine, “Why Not Physician-Assisted Death?” The article sparked several letters to the editor, an editorial, and a response from Manthous, titled "Flawed Assumptions Surround Concept of Physician-Assisted Death." (Crit Care Med. 2009; 37[4]:1206-1209 and Crit Care Med. 2009;37[8]2495-2496) Released: 8/17/09

 SCCM Pod-90 New End-of-Life Guidelines
Robert D. Truog, MD, MA, discusses new guidelines published in the March 2008 issue of Critical Care Medicine, "Recommendations for End-of-Life Care in the ICU." Dr. Truog is professor of medical ethics and anesthesia (pediatrics) at Harvard Medical School and senior associate in critical care medicine at Children's Hospital Boston in Massachusetts.
(Crit Care Med. 2008;36:953-963)

  SCCM Pod-41 CCM: Tough Decisions at the End of Life
Douglas White, MD, discusses his article in the August issue of Critical Care Medicine, "Decisions to Limit Life-Sustaining Treatment for Critically Ill Patients Who Lack Both Decision-Making Capacity and Surrogate Decision Makers." Dr. White is an assistant professor of medicine at the University of California San Francisco Medical Center. (Crit Care Med; 2006, 34(8):2053-2059)

 December 2005 CC: Pediatric End of Life
Robert Truog, MD, FCCM, discusses his article published in the December 2005 issue of Critical Connections, "Pediatric End of Life: Special Needs for Special Children." Dr. Truog is professor of medical ethics and anesthesia, pediatrics at Harvard Medical School, Children's Hospital Boston. He discusses the unique challenges faced in the pediatric intensive care unit by physicians and family members. (Crit Conn 2005 Vol.4 No.6)  

  SCCM Pod-19 Congress Keynotes Up Close: The Courts and End of Life
Timothy Quill, MD, one of seven prominent critical care leaders presenting during the plenary sessions at the 35th Critical Care Congress, discusses the Terry Schiavo case and how courts have played a role in end-of-life decision making. Dr. Quill is a professor of medicine, psychiatry and medical humanities, as well as the director of the Center for Palliative Care and Clinical Ethics at the University of Rochester Medical Center, Rochester, N.Y. 

 December 2005 CC: Improving Family Conferences about End of Life
J. Randall Curtis, MD, MPH, discusses his article in the December 2005 issue of Critical Connections, "Improving Family Conferences About End of Life Care in the ICU." Dr. Curtis is the director of the end-of-life research program at the University of Washington in Seattle. He shares advice on how healthcare professionals can build trust with families with open and honest conversations about patient care and offers techniques and procedures associated with "successful" family conferences. (Crit Conn 2005 Vol.4 No.6)