Chest
Volume 132, Issue 3, September 2007, Pages 748-751
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EDITORIALS
POINT/COUNTERPOINT EDITORIALS
Point: The Ethics of Unilateral “Do Not Resuscitate” Orders: The Role of “Informed Assent”

https://doi.org/10.1378/chest.07-0745Get rights and content

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The Value and Risk of Informed Assent

In the critical care setting, there are specific circumstances when some standard therapies, such as cardiopulmonary resuscitation, may not provide any benefit to the patient. In these circumstances, are clinicians always obliged to obtain informed consent from patients or family members to withhold or withdraw such therapies? Because the process of obtaining informed consent may cause considerable distress for some patients and family members, we contend that obtaining informed assent—when the

Three Categories of Withholding or Withdrawing Life Support

In the ICU, we can identify three categories of decisions to withhold or withdraw life-sustaining therapies that clinicians believe are clearly not indicated; the concept of informed assent is not equally relevant for all three categories. The first category is withholding treatments that patients or family members are not likely to expect for the patients' specific condition (for example an exploratory laparotomy or activated protein C for a moribund patient with severe septic shock and

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      When potentially inappropriate treatments are requested, the guidelines recommend that clinicians communicate and advocate for the treatment plan they believe is most appropriate and if needed, implement a process of conflict-resolution.99 One approach that might minimise the provision of potentially inappropriate interventions in an ICU is to offer patients with decisional capacity, or family members if the patient does not have decisional capacity, the option of deferring decisions to clinicians.100,101 Patients and their family members vary in their desire for decisional control.102,103

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    The authors have no conflicts of interest to disclose.

    Editor's Note:As part of our ongoing Medical Ethics series, we offer this POINT/COUNTERPOINT Debate and frame it with the following vignette: At Grand Rounds regarding end-of-life issues, a visiting professor offered that when cardiopulmonary resuscitation (CPR) is unlikely to promote survival with a reasonable quality of life, he shares his assessment with the patient. If the patient does not object, he enters a “no CPR” order in the patient's medical record.

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