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The study examines the association between religious coping and the use of intensive life-prolonging care at end of life in patients with advanced cancer. Evidence reveals an association between positive religious coping in patients with advanced cancer and the receipt of intensive life-prolonging medical care near death.

Byline: Philippe Conte (1), Denis Baron (1), David Trewick (1), Marie Dominique Touze (1), Celine Longo (1), Irshaad Vial (1), Danielle Yatim (1), Gille Potel (1) Abstract: Objectives Few studies have focused on decisions to withdraw or withhold life-support therapies in the emergency department. Our objectives were to identify clinical situations where life-support was withheld or withdrawn, the criteria used by physicians to justify their decisions, the modalities necessary to implement these decisions, patient disposition, and outcome. Design and setting Prospective unicenter survey in an Emergency Department of a tertiary care teaching hospital. Patients All non-trauma patients (n=119) for whom a decision to withhold or withdraw life-sustaining treatments was taken between January and September 1998. Main outcome measures Choice of criteria justifying the decision to withhold or withdraw life-sustaining treatments, time interval from ED admission to the decision type of decision implemented, outcome. Results Fourteen thousand eight hundred and seventy-five non-trauma patients were admitted during the study period, 119 were included, mean age 75+-13 years. Resuscitation procedures were instituted for 96 (80%) patients before a subsequent decision was taken. Physicians chose on average 6+-2 items to justify their decision the principal acute medical disorder and futility of care were the two criteria most often used. Median time interval to reach the decision was 187 min. Withdrawal involved 37% of patients and withholding 63% of patients. The family was involved in the decision-making process in 72% of patients. The median time interval from the decision to death was 16 h (5 min to 140 days). Conclusion Withdrawing and withholding life-support therapy involved elderly patients with underlying chronic cardiopulmonary disease or metastatic cancer or patients with acute non-treatable illness. Author Affiliation: (1) Service d'Accueil et d'Urgences, Centre Hospitalier Universitaire, 44093 , Nantes, France Article History: Registration Date: 24/09/2004 Received Date: 30/03/2004 Accepted Date: 15/09/2004 Online Date: 29/10/2004 Article note: An editorial regarding this article can be found in the same issue (http://dx.doi.org/10.1007/s00134-004-2476-1)

Byline: L. A. Eidelman (1), D. J. Jakobson (1), R. Pizov (1), D. Geber (1), L. Leibovitz (1), C. L. Sprung (1) Keywords: Key words Do-not-resuscitate; Forgoing; Withholding; Withdrawing; Life-sustaining treatments; Intensive care unit Abstract: Objective: To determine whether physicians in Israel withhold and/or withdraw life-sustaining treatments. Design: A prospective, descriptive study of consecutively admitted patients. Patients were prospectively evaluated for diagnoses, types and reasons for forgoing life-sustaining treatments, mortality and times from forgoing therapy until mortality. Setting: A general intensive care unit of a university hospital in Israel. Results: Forgoing life-sustaining treatment occurred in 52 (13.5 %) of 385 patients admitted and 5 (1 %) had cardiopulmonary resuscitation. Withholding therapy occurred in 48 patients. Four patients with brain death had all treatments withdrawn. No patient had antibiotics, nutrition or fluids withheld or withdrawn. Time from forgoing therapy until death was 2.9 +- 0.6 days. Thirty-one of 48 (65 %) patients who had therapy withheld died within 48 h. Conclusions: Withholding life-prolonging treatments is common in an Israeli intensive care unit whereas withdrawing therapy is limited to brain dead patients. Terminal patients die soon after withholding, even if the therapy is not withdrawn. Withholding treatments should be an option for patients and professionals who object to withdrawing therapies. Author Affiliation: (1) Department of Anesthesiology and Critical Care Medicine, Institute of Medicine, Ethics and Law, Hadassah University Medical Center, The Hebrew University of Jerusalem, P. O. Box 12000, 91120 Jerusalem, Israel Fax: + 9 72 (2) 5 63 54 43, IL Article note: Received: 22 April 1997 Accepted: 6 November 1997

The numerous problems faced by displaced Iraqis who became refugees in other countries are discussed. It is suggested that external community should back host countries like Syria, Jordan and Egypt in order to provide prolonged services to Iraqi refugees.

The most important ethical standard of medicine has traditionally been to benefit the patient by preserving life, treating disease, and reducing pain. Other key principles include doing no harm, respecting patient autonomy (the rights of patients to make decisions about their care), and serving social justice, meaning allocating medical services fairly according to greatest need. These ethical principles are the basis for the relationship between physician and patient and can usually be readily upheld in the doctor's office or during an uncomplicated hospital admission. But this relationship can break down in the intensive care unit (ICU), where a patient's private physician must often turn control over to specialists who have never met the patient and decisions must be made rapidly due to the critical medical condition of the patient. Frequently, patients are not able to express their preferences about treatments physicians wish to use. While these circumstances are difficult, the principles of medical ethics can be applied in the ICU, and are upheld on a daily basis by physicians experienced at working in the critical care setting. In this article, ethical issues are discussed primarily to inform the physician in training and the doctor who rarely treats patients in the ICU. The issues covered are medical decision making, informed consent, resuscitation, brain death and organ transplantation, withholding life support, and allocation of medical resources. Some of the most difficult ethical conflicts could be avoided if individuals would make their wishes for medical care known before an emergency hospital admission; "living wills" are one way of clarifying the patient's wishes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract Nurses and other carers of people with learning disabilities must be able to manage choking events and perform basic life support effectively. UK guidelines for assessment of airway obstruction [...]

Emergency care practitioners often use a standard approach to advanced trauma life support involving oxygenation, ventilation and circulation. After successful resuscitation however, the challenge of care during the recovery phase [...]

Resuscitation skills are recognised as fundamental for most healthcare professionals, including nurses, yet the literature suggests that unless taught repeatedly, these skills can degrade quickly. Resuscitation of infants and children [...]