Three Patients - International Perspective on Intensive Care at the End of Life

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This volume explores how the scarce resources of intensive care units should be distributed. Three hypothetical patients, each with a different chance of survival, desire intensive care. A multinational panel of experienced critical care physicians offers assessments of the patients' conditions and outlines approaches to treatment. These approaches are then examined by academic medical experts and a medical ethicist, as well as from a legal perspective. The result is a well-rounded and introspective look at care for critically ill patients at or near the end of life.

Three Patients - International Perspective on Intensive Care at the End of Life Review

An interesting book, probably unique in its kind. Dr Crippen is an intensive care specialist from Pittsburgh, Pennsylvania who in 1996 started an international internet discussion group (CCM-L) to deal with many issues involving critically ill patients. More than 1,000 members have enrolled. This is exceptional in the sense that for the first time health care professionals and providers from all over the world were able to interact and exchange information and opinions in such a direct, facile, almost immediate way.A fundamental problem - As the population ages and life may be "artificially" extended with the use of sophisticated and often expensive technical support, ICU availability and costs have become an issue of growing public importance and concern. Dr Crippen created three hypothetical patients and asked critical care providers from all over the globe to offer their comments on their management. The result is this remarkable book which is surprisingly easy to read despite the use of specialized terminology. Different perspectives based on different cultures and socioeconomic backgrounds emerge as the reader proceeds. A physician from South Africa describes the huge demand for ICU beds and the limited availability. Physicians from India and Russia underline the importance of the patient's social and financial status and what impact this may have on future decisions related to hers/his critical care. A physician from the Netherlands describes the universal coverage health system available in his country and how the decision for further care rests primarily on the physician's medical judgment. A physician from Israel tries to achieve a balance between religious constraints and futile care. And at the end of the book, non-physician critical care providers contribute with vivid descriptions of pertinent cases and with their perception of futility. Among them, a hospital chaplain describes how she helps her patients deal with the fear of the incoming inevitable death by bringing them closer to a picture of a God who is love, mercy and compassion instead of fear, punishment and revenge.It is evident throughout the book that one of the major issues shaping critical care costs and distribution in the USA is unlimited patient autonomy and overzealous litigation. Increased physician mistrust on behalf of the patients is stated as a major cause of this phenomenon. Whereas many physicians outside USA would assume a role conceived as paternalistic for the USA standards, patients in the USA are often offered a menu of available option regarding their future critical care treatment ("Mr. Jones, in case your breathing worsens do you want us to proceed with mechanical ventilation? In the event your heart stops, do you want us to start chest compressions?" and so on... )Under the editing of Dr's Crippen, Kilcullen and Kelly a balance and an answer is sought. It is not an easy task but the team involved is one of the best international teams available. I highly recommend this book. It underlines once again the concept that a good question is often more important than the answer. Help other customers find the most helpful reviews� Was this review helpful to you?�Yes No Report abuse | PermalinkComment Comment

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