Noel Gerard McElvaney
Shane J O'Neill
David Smith
Ciaran F Donegan
Maura G Flynn
Sanjay Haresh Chotirmall



decision making ethics personal autonomy professional family relations tracheostomy value of life prognosis male critical care withholding treatment intubation intratracheal beneficence hypoxia brain therapy adult great britain legislation jurisprudence quality of life humans

Extubation versus tracheostomy in withdrawal of treatment-ethical, clinical, and legal perspectives. (2009)

Abstract The provision of life-sustaining ventilation, such as tracheostomy to critically ill patients, is commonly performed. However, the utilization of tracheostomy or extubation after a withdrawal of treatment decision is debated. There is a dearth of practical information available to aid clinical decision making because withdrawal of treatment is a challenging scenario for all concerned. This is further complicated by medicolegal and ethical considerations. Care of the "hopelessly ill" patient should be based on daily evaluation and comfort making it impossible to fit into general algorithms. Although respect for autonomy is important in healthcare, it is limited for patients in an unconscious state. Beneficence remains the basis for withdrawing treatment in futile cases and underpins the "doctrine of double effect." This article presents a relevant clinical case of hypoxic brain injury where a question of withdrawal of treatment arose and examines the ethical, clinical, and medicolegal considerations inherent in such cases, including beneficence, nonmaleficence, and the "sanctity of life doctrine." In addition, the considerations of prognosis for recovery, patient autonomy, patient quality of life, and patient family involvement, which are central to decision making, are addressed. The varying legal frameworks that exist internationally regarding treatment withdrawal are also described. Good ethics needs sound facts, and despite the lack of legal foundation in several countries, withdrawal of treatment remains practiced, and the principles described within this article aim to aid clinician decision making during such complex and multifaceted end-of-life decisions.
Collections Ireland -> Royal College of Surgeons in Ireland -> PubMed

Full list of authors on original publication

Noel Gerard McElvaney, Shane J O'Neill, David Smith, Ciaran F Donegan, Maura G Flynn, Sanjay Haresh Chotirmall

Experts in our system

Noel G McElvaney
Royal College of Surgeons in Ireland
Total Publications: 194
Shane J O'Neill
Royal College of Surgeons in Ireland
Total Publications: 84
David Smith
Royal College of Surgeons in Ireland
Total Publications: 3
Sanjay H Chotirmall
Royal College of Surgeons in Ireland
Total Publications: 22