Professor Charles Sprung: "Foregoing Life-Sustaining Treatment in the ICU"

Medical practices at the end of life differ around the world. In the United States, medicine has moved from a paternalistic model to one that promotes autonomy and self-determination.  In Europe and other regions of the world, patient-physician relationships are still somewhat paternalistic. Different cultures and countries deal in diverse ways with the ethical dilemmas arising as a consequence of the wider availability of life-sustaining therapies. In the past patients died in intensive care units (ICUs) despite ongoing aggressive therapy. Over the years, observational studies documenting physician behavior have noted changes in the modes of patient deaths and an earlier limitations of life-sustaining treatments. This lecture will review the current global practices.