Life and death decisions for incompetent patients: determining best interests--the Irish perspective.

Hdl Handle:
http://hdl.handle.net/10147/206235
Title:
Life and death decisions for incompetent patients: determining best interests--the Irish perspective.
Authors:
Armstrong, K; Ryan, C A; Hawkes, C P; Janvier, A; Dempsey, E M
Affiliation:
Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland.
Citation:
Acta Paediatr. 2011 Apr;100(4):519-23. doi: 10.1111/j.1651-2227.2010.02084.x., Epub 2010 Dec 3.
Journal:
Acta paediatrica (Oslo, Norway : 1992)
Issue Date:
31-Jan-2012
URI:
http://hdl.handle.net/10147/206235
DOI:
10.1111/j.1651-2227.2010.02084.x
PubMed ID:
21070357
Abstract:
AIMS: To determine whether healthcare providers apply the best interest principle equally to different resuscitation decisions. METHODS: An anonymous questionnaire was distributed to consultants, trainees in neonatology, paediatrics, obstetrics and 4th medical students. It examined resuscitation scenarios of critically ill patients all needing immediate resuscitation. Outcomes were described including survival and potential long-term sequelae. Respondents were asked whether they would intubate, whether resuscitation was in the patients best interest, would they accept surrogate refusal to initiate resuscitation and in what order they would resuscitate. RESULTS: The response rate was 74%. The majority would wish resuscitation for all except the 80-year-old. It was in the best interest of the 2-month-old and the 7-year-old to be resuscitated compared to the remaining scenarios (p value <0.05 for each comparison). Approximately one quarter who believed it was in a patient best interests to be resuscitated would nonetheless accept the family refusing resuscitation. Medical students were statistically more likely to advocate resuscitation in each category. CONCLUSION: These results suggest resuscitation is not solely related to survival or long-term outcome and the best interest principle is applied differently, more so at the beginning of life.
Language:
eng
MeSH:
Adolescent; Adult; Age Factors; Aged, 80 and over; Attitude of Health Personnel; Child; *Decision Making; Humans; Infant; Infant, Newborn; Infant, Premature; Ireland; Life Support Care; *Mental Competency; Middle Aged; Neonatology/standards; Obstetrics/standards; Pediatrics/standards; *Physician's Practice Patterns; *Physician-Patient Relations; Resuscitation/*standards; Students, Medical/psychology
ISSN:
1651-2227 (Electronic); 0803-5253 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorArmstrong, Ken_GB
dc.contributor.authorRyan, C Aen_GB
dc.contributor.authorHawkes, C Pen_GB
dc.contributor.authorJanvier, Aen_GB
dc.contributor.authorDempsey, E Men_GB
dc.date.accessioned2012-01-31T16:43:34Z-
dc.date.available2012-01-31T16:43:34Z-
dc.date.issued2012-01-31T16:43:34Z-
dc.identifier.citationActa Paediatr. 2011 Apr;100(4):519-23. doi: 10.1111/j.1651-2227.2010.02084.x., Epub 2010 Dec 3.en_GB
dc.identifier.issn1651-2227 (Electronic)en_GB
dc.identifier.issn0803-5253 (Linking)en_GB
dc.identifier.pmid21070357en_GB
dc.identifier.doi10.1111/j.1651-2227.2010.02084.xen_GB
dc.identifier.urihttp://hdl.handle.net/10147/206235-
dc.description.abstractAIMS: To determine whether healthcare providers apply the best interest principle equally to different resuscitation decisions. METHODS: An anonymous questionnaire was distributed to consultants, trainees in neonatology, paediatrics, obstetrics and 4th medical students. It examined resuscitation scenarios of critically ill patients all needing immediate resuscitation. Outcomes were described including survival and potential long-term sequelae. Respondents were asked whether they would intubate, whether resuscitation was in the patients best interest, would they accept surrogate refusal to initiate resuscitation and in what order they would resuscitate. RESULTS: The response rate was 74%. The majority would wish resuscitation for all except the 80-year-old. It was in the best interest of the 2-month-old and the 7-year-old to be resuscitated compared to the remaining scenarios (p value <0.05 for each comparison). Approximately one quarter who believed it was in a patient best interests to be resuscitated would nonetheless accept the family refusing resuscitation. Medical students were statistically more likely to advocate resuscitation in each category. CONCLUSION: These results suggest resuscitation is not solely related to survival or long-term outcome and the best interest principle is applied differently, more so at the beginning of life.en_GB
dc.language.isoengen_GB
dc.subject.meshAdolescenten_GB
dc.subject.meshAdulten_GB
dc.subject.meshAge Factorsen_GB
dc.subject.meshAged, 80 and overen_GB
dc.subject.meshAttitude of Health Personnelen_GB
dc.subject.meshChilden_GB
dc.subject.mesh*Decision Makingen_GB
dc.subject.meshHumansen_GB
dc.subject.meshInfanten_GB
dc.subject.meshInfant, Newbornen_GB
dc.subject.meshInfant, Prematureen_GB
dc.subject.meshIrelanden_GB
dc.subject.meshLife Support Careen_GB
dc.subject.mesh*Mental Competencyen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshNeonatology/standardsen_GB
dc.subject.meshObstetrics/standardsen_GB
dc.subject.meshPediatrics/standardsen_GB
dc.subject.mesh*Physician's Practice Patternsen_GB
dc.subject.mesh*Physician-Patient Relationsen_GB
dc.subject.meshResuscitation/*standardsen_GB
dc.subject.meshStudents, Medical/psychologyen_GB
dc.titleLife and death decisions for incompetent patients: determining best interests--the Irish perspective.en_GB
dc.contributor.departmentDepartment of Neonatology, Cork University Maternity Hospital, Cork, Ireland.en_GB
dc.identifier.journalActa paediatrica (Oslo, Norway : 1992)en_GB
dc.description.provinceMunster-
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