END-OF-LIFE COMMUNICATION IN THE ICU: A GLOBAL PERSPECTIVE
Author: David W. Crippen, MD
Bibliographic Data: Springer, 2008. ISBN: 978-0-387-72965-7, 180 pages, hard cover, $79.95.
Reviewer's Expert Opinion
Description: This is a multiauthored collection of perspectives on medical futility, its communication, and its management in the critical care setting. Purpose: Communication issues which affect formulation of treatment plans for patients at the end-of-life in intensive care units are discussed. Audience: Senior staff, fellows, and residents at all levels are an appropriate audience for this work which originates from a multinational set of authors with an interest in end-of-life care. Features: The book begins with a brief presentation of Western European, United States, Asian, and Latin American perspectives on the issues. Fundamentals of communication and biology of multiorgan failure are briefly discussed followed by a series of chapters focused on communication with patients and their surrogate decision makers. Discussion topics include autonomy, communication of futility, emotions associated with end-of-life, medical liability, and the role of ethics committees. While the majority of perspectives come from physicians, comments from a bedside nurse, chaplain, and pharmacist reviewing pharmacotherapy are also included. Chapters are brief and frequently include clinical anecdotes to facilitate discussion. Some presentations make extensive use of primary literature with citations dating to within two years of publication while others do not include references. Web sites and popular media are sometimes included to document public perspectives. A concluding index of 10 pages provides adequate access to topics. Assessment: This book shares insights on the need for a focused discussion of communication with surrogate decision makers in the ICU. Although the discussion of the biology of death seems out of place, communication perspectives are well thought out and presented.
Reviewer: David J. Dries, MD (University of Minnesota Medical School)