Manthous Constantine A
Department of Internal Medicine, Bridgeport Hospital and Yale University School of Medicine, CT 06610, USA.
Conn Med. 2005 Aug;69(7):395-400.
To describe intensivist-educators' practices and opinions regarding the withdrawal of life-sustaining therapies, and to juxtapose these with applicable end-of-life statutes.
A questionnaire was sent to critical care program directors in Connecticut, New York, Illinois, California, Florida and Texas (to examine regional variability). Statutes regarding end-of-life care were ascertained for these states.
Sixty-eight of 128 queried intensivists responded to the questionnaire. They reported having withdrawn life-sustaining therapies to a median of 28 patients in the previous year. Overall, respondents answered that of patients in whom they had withdrawn life-sustaining therapies, 55% were terminal, 20.5% weren't necessarily terminal but advance directives were applied to the situation and 22% weren't necessarily terminal but families requested withdrawal. The ranges of responses were highly variable (ranging from 5%-100% patients deemed terminal). All respondents agreed that withdrawal should be allowed in non-terminal conditions in which the likelihood or quality of survival would be unacceptable to the patient. Forty-eight respondents answered that advanced Alzheimer's Disease qualifies as a terminal illness. Connecticut's end-of-life statutes were unlike those in the five other states that allowed withdrawal of life-sustaining therapies based on advance directives and/or surrogates' consent. Practices of Connecticut respondents were similar to other sampled states.
These data suggest that Connecticut's statutes requiring that patients be deemed terminal (or permanently unconscious) before withdrawal of care are dissimilar from those in several other states. Connecticut intensivists who responded to our survey appear to practice end-of-life care that is similar to practices elsewhere.
描述重症监护教育工作者在撤除维持生命治疗方面的做法和观点，并将这些与适用的临终法规进行对比。
向康涅狄格州、纽约州、伊利诺伊州、加利福尼亚州、佛罗里达州和得克萨斯州的重症监护项目主任发送了一份调查问卷（以研究地区差异）。确定了这些州关于临终护理的法规。
128名被调查的重症监护医生中有68人回复了问卷。他们报告称，在上一年中，平均每位医生撤除维持生命治疗的患者为28例。总体而言，受访者表示，在他们撤除维持生命治疗的患者中，55%为终末期患者，20.5%不一定是终末期患者，但适用预先指示，22%不一定是终末期患者，但家属要求撤除治疗。回答的范围差异很大（认为是终末期患者的比例从5%到100%不等）。所有受访者都同意，在非终末期情况下，如果患者的生存可能性或质量不可接受，应允许撤除治疗。48名受访者回答称，晚期阿尔茨海默病可被视为绝症。康涅狄格州的临终法规与其他五个允许根据预先指示和/或代理人同意撤除维持生命治疗的州不同。康涅狄格州受访者的做法与其他抽样州相似。
这些数据表明，康涅狄格州要求在撤除护理前患者必须被视为终末期（或永久昏迷）的法规与其他几个州不同。回复我们调查的康涅狄格州重症监护医生的临终护理做法似乎与其他地方的做法相似。
