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Oxford Textbook of Medicine (5 ed.)

Edited by David A. Warrell, Timothy M. Cox, John D. Firth

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Latest update

The November 2012 update sees updates to over 70 chapters, focusing on Neurology and Gastroenterology. This update also incorporates a selection of 29 Case Histories taken from related titles in the Oxford Case Histories series, linked to from related chapters. Each case includes several questions followed by detailed answers and discussion to enhance diagnostic and clinical understanding.

Neurology updates include substantial updates to key chapters and new material on a wide range of topics including spinal cord injury, autonomic nervous system disorders, and inherited neurodegenerative diseases. 

Gastroenterology updates include extensive revisions of key chapters on liver failure and acute pancreatitis and new material on a wide range of matters, ranging from the common to the rare: including surgical treatments for colonic diverticular disease, antibody tests for immune disorders, and a revised treatment algorithm for small bowel bacterial overgrowth.

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Publisher:
Oxford University Press
Print Publication Date:
May 2010
Print ISBN-13:
9780199204854
Published to Oxford Medicine:
May 2012
DOI:
10.1093/med/9780199204854.001.1

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Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

Discontinuing treatment of the critically ill patient

Chapter:
Discontinuing treatment of the critically ill patient
Author(s):

M.J. Lindop

DOI:
10.1093/med/9780199204854.003.1708

A patient may have made an advance directive before the moment of decision about life-prolonging treatments, and their view is paramount. However, many patients have not made such a directive, and in this circumstance the responsibility for such decisions remains with the doctor.

Most people agree that prolongation of life itself is not necessarily a benefit: it is only valuable if that life is of adequate quality. Continuing aggressive treatment of a patient who is severely ill may not be kind or sensible.

Depending on the clinical situation, it may be appropriate to decide not to escalate treatment, not to attempt cardiopulmonary resuscitation in the event of circulatory arrest, or to withdraw treatment. Key points in management in such circumstances are:

Once a decision to withdraw treatment is made, then a drug or a feeding regimen can simply be stopped, and an intermittent therapy such as haemofiltration can be omitted. Terminal weaning is a protocol that allows death with dignity as mechanical ventilation is discontinued without causing distress to the patient or the family and carers.

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