Dying Patients in the Intensive Care Unit

Stephen Workman

doi:10.7326/0003-4819-135-12-200112180-00021

Letters |18 December 2001

Dying Patients in the Intensive Care Unit

Stephen Workman, MD, MSc, FRCP

Article, Author, and Disclosure Information

TO THE EDITOR:

In the article by Faber-Langendoen and Lanken on dying patients in the intensive care unit (ICU), part of the case report states, “The ICU physician tells Mrs. McGee that her husband's chance of surviving is less than 10% and that even if he does survive, he will need long-term ventilator support and dialysis. Although Mr. McGee has no written advance directive, his family is certain that he would not want ICU care continued given the prospects” (1).

Although the article itself was very helpful, the conversational template was less so. How is it known that the chance of survival is less than 10%? Should the family have been told the source of this crucial information? “Even” if Mr. McGee survives? Why include the word even? The odds of survival have already been given and clearly communicate that death is the most likely outcome of continued treatment. To include the word even runs the risk of demonstrating bias against continued treatment. “Long-term ventilator support and dialysis”? How long is long-term? A month, a week, or a year? Such details are important. Finally, despite a 90% probability of death, the words death and dying are not used. Perhaps it would have been more accurate to say, “I'm very sorry, but the odds are your husband is going to die no matter what we do.”

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2001 American College of Physicians

Letters |18 December 2001

Dying Patients in the Intensive Care Unit

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Letters |18 December 2001

Dying Patients in the Intensive Care Unit

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