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Worldwide end-of-life practice for patients in ICUs

Wong, Wai-Tata; Phua, Jasonb; Joynt, Gavin M.a

Current Opinion in Anesthesiology: April 2018 - Volume 31 - Issue 2 - p 172–178
doi: 10.1097/ACO.0000000000000563
ETHICS, ECONOMICS AND OUTCOME: Edited by Stanley H. Rosenbaum

Purpose of review Published data and practice recommendations on end-of-life (EOL) generally reflect Western practice frameworks. Understanding worldwide practices is important because improving economic conditions are promoting rapid expansion of intensive care services in many previously disadvantaged regions, and increasing migration has promoted a new cultural diversity previously predominantly unicultural societies. This review explores current knowledge of similarities and differences in EOL practice between regions and possible causes and implications of these differences.

Recent findings Recent observational and survey data shows a marked variability in the practice of withholding and withdrawing life sustaining therapy worldwide. Some evidence supports the view that culture, religion, and socioeconomic factors influence EOL practice, and individually or together account for differences observed. There are also likely to be commonly desired values and expectations for EOL practice, and recent attempts at establishing where worldwide consensus may lie have improved our understanding of shared values and practices.

Summary Awareness of differences, understanding their likely complex causes, and using this knowledge to inform individualized care at EOL is likely to improve the quality of care for patients. Further research should clarify the causes of EOL practice variability, monitor trends, and objectively evaluate the quality of EOL practice worldwide.

aDepartment of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong

bDivision of Respiratory and Critical Care Medicine, National University Hospital, National University Health System, Singapore

Correspondence to Professor Gavin M. Joynt, MBBCh, FFA (SA), FRCP, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Room 04D24, 4/F, Shatin, Hong Kong. Tel: +852 35051313; e-mail:

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