Chest

Chest

Volume 126, Issue 6, December 2004, Pages 1969-1973
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Ethics in Cardiopulmonary Medicine
Evaluation of Changes in Forgoing Life-Sustaining Treatment in Israeli ICU Patients

https://doi.org/10.1378/chest.126.6.1969Get rights and content

Introduction:

Over the last several years, there have been legal decisions and changes in medical directives concerning end-of-life decisions in Israel.

Methods:

The data were compared to evaluate the changes in the frequency and types of forgoing of life-sustaining treatment (FLST) in patients who were admitted to the ICU during period I (November 1994 to July 1995) and period II (January 1998 to January 1999).

Results:

During period I, there were 385 ICU admissions, and during period II there were 627 ICU admissions. In period I, FLST or death occurred in 13.5% of patients, and in 12% in period II. There was no significant difference in cardiopulmonary resuscitation (9% vs 13%, respectively), withholding therapy (90% vs 91%, respectively), or withdrawing therapy (0% vs 0%, respectively) between the two study periods.

Conclusions:

There was no significant change in the frequency or types of FLST in an Israeli ICU between 1994 and 1998, despite passage of a new Patients’ Rights Law and the issuing of a Ministry of Health directive on the treatment of the terminally ill, both of which occurred in 1996, and recent district court decisions favoring the termination of life-sustaining therapies.

Section snippets

Materials and Methods

The study was conducted in a 650-bed, academic, tertiary care referral center. All patients admitted to the ICU from January 1, 1998, until December 31, 1998, were evaluated prospectively. All patients who died and/or had any type of limitation of medical treatment were included in the study. The attending critical care physician, who was responsible for the care and decision making for the patient, completed a form describing the patient’s age, sex, diagnosis, acute and chronic illnesses,

Results

From January 1, 1998, through December 31, 1998, a total of 627 patients were admitted to the ICU. The mean age was 59 ≤ 3 years. The ICU admission diagnoses for study patients are listed in Table 1.

Seventy-seven patients died and/or had the FLST (12%). Of these 77 patients, 72 (94%) received mechanical ventilation and 70 (91%) received vasopressor agents. Although FLST occurred in 69 of the 77 study patients (90%), such FLST occurred in only 11% of the total 627 patients admitted to the ICU.

Discussion

Over the last several decades, society has had to deal with the ethical and moral problems related to the care of terminally ill patients. Cultural, legal, and religious factors have influenced this end-of-life decision making.11 In more recent years, FLST has undergone significant changes, particularly in the Western world.29

The present study shows that Israeli doctors accept the FLST as a valid alternative for those patients who fail to respond to treatment. The predominant FLST practice was

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    • Cited by (0)

    This study was funded in part by the Chief Scientist’s Office of the Ministry of Health, Israel (grant 4226).

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    Copyright © 2004 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.