NET_Topic_20050330_Terminal_Extubation.doc

NET_Topic_20050330_Terminal_Extubation.doc - The...

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The information contained in Ethics Center publications is current as of the date of publication. However, health care ethics is a dynamic field in which best practices and thinking are constantly evolving. Therefore, some information in older publications may become outdated or may be superseded. We encourage users to consult additional and more recent authorities on these topics. 1
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National Ethics Teleconference Terminal Extubation: Ethics Perspectives March 30, 2005 INTRODUCTION Dr. Berkowitz: Good day everyone. This is Ken Berkowitz. I am the Chief of the Ethics Consultation Service at the VHA National Center for Ethics in Health Care and a physician at the VA NY Harbor Healthcare System. I am very pleased to welcome you all to today's National Ethics Teleconference. By sponsoring this series of calls, the Center provides an opportunity for regular education and open discussion of ethical concerns relevant to VHA. Each call features an educational presentation on an interesting ethics topic followed by an open, moderated discussion of that topic. After the discussion, we reserve the last few minutes of each call for our 'from the field section'. This will be your opportunity to speak up and let us know what is on your mind regarding ethics related topics other than the focus of today's call. PRESENTATION Dr. Berkowitz : Today’s presentation will focus on the topic Terminal Extubation from an ethics perspective. This will include a discussion of ethics concerns and ethical practices related to terminal extubation. Joining me on today’s call is Dr. Alice Beal, a pulmonologist and intensivist who is currently Director of Palliative Care at the New York Harbor Healthcare System. Thank you, Dr. Beal, for being on the call today. I would like to begin by asking Dr. Beal to get us all on the same page by telling us exactly what is terminal extubation. Dr. Beal : Terminal extubation is the withdrawal of mechanical ventilation from patients who are not expected to sustain independent respiration without it. Dr. Berkowitz : In other words in certain patients the mechanical ventilation is prolonging the patient’s dying process and removing it at the patient or surrogate’s request is allowing nature to take its course. 2
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Dr. Beal : Yes. Dr. Berkowitz : How did you get interested in this topic? Dr. Beal : During my years in the ICU I had several difficult cases where patients or their surrogates were requesting extubation. Even though it was clear to team members and myself that extubation was the ethically justifiable thing to do, we were not sure about the details. This pointed out to me the lack of defined standards and clear practice guidelines for terminal extubation. First I turned to the literature to learn what was known about this practice. I can provide a brief historical overview.
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  • Spring '14
  • DeniseMitchell
  • Decision Making, Health care provider, Intensive care medicine, Dr. Berkowitz, Dr. Alice Beal

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