Life-Sustaining Therapies: Indication, Prognostication, and the Patient’s Wishes

Abstract

Since treatment in an intensive care unit (ICU) can be burdensome and the outcome may be disappointing, the benefit and harm of an ICU treatment should be assessed repeatedly to adhere to the patient’s wishes. This should be done within a process of careful and shared decision-making, in which clinicians and patients or their surrogate decision-makers make rational, evidence-based, and individualized healthcare decisions. In this way, prognosis, proportionality, and patient preferences can be aligned in order to provide proportional and goal-concordant care. In this chapter, we well expound the process of making individualized decisions concerning life-sustaining treatments in the ICU. We will describe the prognosis of ICU patients concerning mortality, morbidity, and quality of life. We will explicit the concept of goal-concordant care, explain how advance care planning can or can’t help in decision-making and what the role of substituted judgment is in life-sustaining treatment decisions in incapacitated ICU patients.