Table 1

Slightly adapted version of the front page of the ‘checklist of considerations’

© EMGO-Institute August 1997
EMGO/HVSG Vrije Universiteit, Amsterdam
Points to consider in the decision process for starting or not starting a curative treatment of pneumonia in psychogeriatric patients
Instruction
The list has been constructed as a questionnaire. Every section ends with a concluding question, after which is included a block with explanatory text, which refers to a part of, or all answer categories. Hereafter one is led to the next section which is applicable to this patient. The last page but one consists of a summarizing survey (section D), which one should fill out to visualize the main considerations on one page to be of use for the decision process.
The purpose of this list of ‘points to consider’ is to assist nursing home physicians in the decision process for starting or not starting a curative treatment of pneumonia in psychogeriatric nursing home patients. The list is not designed to direct the physician to a certain treatment decision. Structuring the decision process is done by carefully and systematically recording some medical aspects, and especially the aspects that are important to consider in the decision process from a legal and ethical point of view. Naturally, in all cases the responsibility for the final decision lies in the hands of the responsible treating physician.
The main guiding variables in the decision process are:
1. the expected effect of a curative treatment from the medical perspective;
2. the patient's wish: a living will, or the reconstruction of the wish;
3. the patient's best interest in case the wish of the patient is not clear, or remains unknown.
Definitions Experts
(Intentionally) curative treatment of pneumonia: The following experts have commented on the list of points to consider, and have subsequently subscribed to the list:
a treatment of pneumonia that has achieving cure as the primary goal. J J M van Delden, MD, PhD (the Netherlands)
Explanation: this is irrespective of the chance of success of curing pneumonia. The treatment consists of antibiotics, which can be combined with (re)hydration. Nevertheless, the course of the disease may necessitate installing palliative treatment as well. Prof H M Dupuis, PhD (the Netherlands)
Palliative treatment of pneumonia: L Emanuel, MD, PhD (USA)
a treatment whose primary goal is not cure, but is aimed at treating the symptoms of the pneumonia. C M P M Hertogh, MD, PhD (the Netherlands)
Explanation: the aim of this is to improve the patient's wellbeing and quality of life. Palliative use of antibiotics - when achieving cure is not the primary goal - can be meant by this as well. A Hoogerwerf, MD (the Netherlands)
Prof H Kuhse, PhD, (Australia)
Prof H D C Roscam Abbing, LLD (the Netherlands)
Prof J M Stanley (USA)
This list with points to consider has been autorized by the Dutch Society for Nursing Home Physicians (NVVA) for the present, on behalf of the Pneumonia Study.