Family reliance on physicians' decisions in life-sustaining treatments in acute-on-chronic respiratory diseases in a respiratory ICU: a single-center study

Abstract

Background: In ICUs, many patients are unable to participate in decision-making regarding life-sustaining treatments. This study evaluated the opinions of family members about family and physician participation in life-sustaining treatment decisions and examined factors that influence those decisions.

Methods: This was a prospective exploratory observational study that used convenience sampling. Inquiry interviews were conducted over a 3-year period, with 126 family members (out of 303 potential participants) of patients with acute-on-chronic respiratory failure, who had been admitted to the respiratory ICU and were dependent on invasive or noninvasive mechanical ventilation. Patients of ≤ 18 years old, with a stay of < 3 days, and oncologic patients were excluded.

Results: Ninety-eight percent (123/126) of the participant family members had an opinion about their involvement in decision-making about life-sustaining treatments. Physician choice was preferred by 54/123 (44%), 55/123 (45%) wished to share the decision with the physician, and 14/123 (11%) wished the family to decide. All the patients were incompetent at the time of inquiry. Autonomy prior to admission to the respiratory ICU influenced the decision.

Conclusions: A majority of the families relied on physicians to help in the decision-making process about life-sustaining treatments in patients with acute-on-chronic respiratory diseases. From the family's point of view, the principle of autonomy can be exercised by delegating the decision-making process to the physician. To assume a uniform ethical conduct is to antagonize the definition of ethics.

Keywords: death; decision-making; end of life; surrogate.