[Changing the therapeutic goal in critically ill patients. Ethical analysis of a surgical case]

Details

Serval ID
serval:BIB_C948A43FA58B
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Title
[Changing the therapeutic goal in critically ill patients. Ethical analysis of a surgical case]
Journal
Unfallchirurg
Author(s)
Jox R. J., Ney L.
ISSN
1433-044X (Electronic)
ISSN-L
0177-5537
Publication state
Published
Issued date
05/2014
Volume
117
Number
5
Pages
399-405
Language
german
Notes
Jox, R J
Ney, L
ger
Case Reports
English Abstract
Germany
2014/05/17 06:00
Unfallchirurg. 2014 May;117(5):399-405. doi: 10.1007/s00113-013-2455-5.
Abstract
We report on a 32-year-old patient, who developed septic shock, toxic shock-like syndrome, and multiple organ failure following nectrotizing fasciitis. Amputations had to be performed on all extremities. Subsequently, she developed secondary sclerosing cholangitis. Treatment goals had to be reassessed, since long-term survival seemed doubtful and, in the best case, burdened with severe handicap. We discuss the evaluation of the treatment goals, utilizing a structured model of goal-setting. In the first step the treatment goal is identified based on the patient's wishes. This goal's realistic achievability is verified considering scientific evidence and medical experience. The benefit of the aspired goal is set in relation to risks and burden of the necessary treatment measures in a third step. The resulting benefit-risk ratio must be evaluated by the patient or her representative. Treatment goals have to be reevaluated if the assessment of achievability or the benefit-risk ratio are disadvantageous. In this case, the initial therapeutic goal was retained. After an extraordinarily prolonged and complex therapy including reconstructive surgery the patient is now living independently at home.
Keywords
Adult, Amputation/*ethics, Critical Illness/*therapy, Decision Making/*ethics, Decision Support Techniques, Female, Germany, Humans, Patient Care Planning/*ethics, Patient-Centered Care/ethics, Physician-Patient Relations/*ethics, Surgical Procedures, Operative/*ethics, Traumatology/*ethics
Pubmed
Create date
14/07/2017 9:09
Last modification date
20/08/2019 15:44
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