| 英文摘要 |
End-of-life care (EOLC) is emerging as a comprehensive area of expertise in intensive care unit (ICU) and demands as high level of knowledge and competence as all other areas of ICU practice. Consensuses are developed to improve the quality of care in ICU for patients and their families during the dying process. Patient and family-centered care and shared decision making has became to the core ideal for managing EOLC in ICU. Improvements of communication is important in practice of ICU care. Three key ethical concepts play fundamental roles in guiding end-of-life care, including the distinctions between withholding and withdrawing treatments, between actions of killing and actions allowing to die, and between consequences that are intended vs. consequences that are merely foreseen (the doctrine of double effect). The treatments should be reevaluated, once the goal of care is shifted from “cure” to “comfort”. Clinicians should be competent in all aspects of this care, especially in practice of withholding and withdrawing of life-sustaining treatment and the use of sedatives, analgesics, and non-pharmacologic approaches to ease the suffering of the dying process. Other knowledge unique to EOLC includes principles for notifying families of a patient’s death, compassionate approaches to discuss possibility of organ donation and bereavement programs (support both families and clinical staffs). In the future, a comprehensive agenda for improving end-of-life care in the ICU should be developed to guide researches, quality improvement efforts, and educational curricula. |
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