Biomaterial Database

Decisions to forego life-sustaining treatment and the duty of documentation. 1996

G Melltorp, and T Nilstun

Department of Anaesthesiology, Central Hospital, Växjö, Sweden.

OBJECTIVE To study the current practice of documenting decisions to forego life-sustaining treatment in an intensive care unit (ICU), using the Swedish Medical Records Act as a frame of reference. METHODS The ICU at Malmoe General Hospital, Sweden. METHODS The medical records of the first 600 cases treated in the ICU in 1992. METHODS Analysis of documents and informal observational procedures. RESULTS Decisions to forego life-sustaining treatment were documented in the medical records of 34 patients, 17 of whom died in the ICU. In many cases, the treatment is specified, but often it is only rather vaguely described. The main reason for foregoing treatment is poor prognosis. There is no indication that the decisions had been discussed with the patients. In 18 of the 34 medical records, there are notes indicating that relatives were informed about the decision. Notes in most of the 34 medical records imply that joint deliberation took place between the anaesthesiologists in the ICU and the other physician(s) responsible for the treatment of the patient. CONCLUSIONS The medical records give a fairly accurate picture of the frequency with which such decisions are made at this particular ICU, although the number might be somewhat underestimated. However, the content of the documentation is rather scanty and does not fully satisfy the requirements of the Swedish Medical Records Act. Further studies are needed to warrant any generalization.

UI	MeSH Term	Description	Entries
D007223	Infant	A child between 1 and 23 months of age.	Infants
D007231	Infant, Newborn	An infant during the first 28 days after birth.	Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D007362	Intensive Care Units	Hospital units providing continuous surveillance and care to acutely ill patients.	ICU Intensive Care Units,Intensive Care Unit,Unit, Intensive Care
D008020	Life Support Care	Care provided patients requiring extraordinary therapeutic measures in order to sustain and prolong life.	Extraordinary Treatment,Prolongation of Life,Care, Life Support,Extraordinary Treatments,Life Prolongation,Treatment, Extraordinary,Treatments, Extraordinary
D008297	Male		Males
D008499	Medical Records	Recording of pertinent information concerning patient's illness or illnesses.	Health Diaries,Medical Transcription,Records, Medical,Transcription, Medical,Diaries, Health,Diary, Health,Health Diary,Medical Record,Medical Transcriptions,Record, Medical,Transcriptions, Medical
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D010818	Practice Patterns, Physicians'	Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided.	Clinical Practice Patterns,Physician's Practice Patterns,Clinical Practice Pattern,Pattern, Clinical Practice,Patterns, Clinical Practice,Practice Pattern, Clinical,Practice Patterns, Clinical,Practice Patterns, Physician's,Prescribing Patterns, Physician,Physician Practice Patterns,Physician Prescribing Pattern,Physician Prescribing Patterns,Physician's Practice Pattern,Physicians' Practice Pattern,Physicians' Practice Patterns,Practice Pattern, Physician's,Practice Pattern, Physicians',Practice Patterns, Physician,Prescribing Pattern, Physician
D011379	Prognosis	A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations.	Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D002648	Child	A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL.	Children