A study presented at the 2014 annual meeting of the Society of Critical Care Medicine (abstract 720) found that patients’ clearly stated wishes not to be resuscitated or placed on life support were not followed in 21 of 35 cases.
The most significant factors in these unwanted intubations were
- intervention by patients’ families to countermand their known wishes (nine cases)
- an inability to locate documentation of patients’ wishes in a timely manner (eight cases)
In three cases, family members or proxies who were aware of the patients’ wishes not to be resuscitated were not present at the time the decision to resuscitate was made. In the remaining case, the patient required immediate intubation before being able to discuss the decision with family members. (Anesthesiology News also here in HTML)
This study is hardly new and surprising. I reviewed similar studies in my recent long article: “Clinicians May Not Administer Life-Sustaining Treatment Without Consent: Civil, Criminal, and Disciplinary Sanctions.” But the newer study certainly does confirm the need to address persistent deficiencies with surrogate decision making, documentation of patient preferences, and the use of POLST.