Ann Thorac Surg 2002;73:1688
© 2002 The Society of Thoracic Surgeons
a Director of Clinical Ethics, Columbia-Presbyterian Medical Center, New York, NY, USA
b Cardiovascular Institute, Department of Surgery, Columbia Presbyterian Center, New York Presbyterian Hospital, MHB 7-435, 177 Fort Washington Ave, New York, NY 10032, USA
To the Editor
As more sophisticated innovations in medical technology enable us to intervene in cases of ever-sicker patients, ICU populations now consist of significant numbers of patients who can be kept alive but who have minimal chances of surviving to discharge. In our hospital, 3% of ICU patients stay more than 14 days, yet this cohort utilizes 25% of the beds annually. This group has a 50% in-hospital mortality with significantly increased mortality over the 2 years post discharge. Often an extended ICU course occurs despite physician judgment that intensive care will not enable the patient to leave the hospital alive, but will result in unnecessary suffering and prolong the dying process. Lack of understanding by patients or their families of the goals and reasonable possibilities of high-risk intervention is often a cause for conflicts and confusion when the issue of cessation of treatment is raised.
The Ethics Committee of the Columbia Presbyterian Center of The New York Presbyterian Hospital has drafted a statement that patients and physicians must review together prior to placement of a ventricular assist device (VAD) or, when circum
stances do not permit, immediately thereafter. The statement asserts that VAD
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