Withholding and Withdrawal of Life-Sustaining Treatments in critically ill ICU patients: A study on attitude of Physicians of Bangladesh

Authors

  • Mohammad Omar Faruq Professor of Critical care Medicine, Chief consultant, General ICU and Emergency dept., United Hospital Ltd, Dhaka 1212, Bangladesh
  • ARM Nooruzzaman Consultant ICU, Bangladesh specialized hospital, Dhaka1207, Bangladesh
  • Rownak Jahan Tamanna Consultant cardiologist and intensivist, Uttara Crescent Hospital, Dhaka 1230, Bangladesh
  • Amina Sultana Junior Consultant, GICU, United Hospital Ltd, Dhaka 1212, Bangladesh
  • Uzzwal Kumar Mallick Registrar and In charge of ICU, National Institute of Neurosciences Hospital, Dhaka 1207
  • Mohammad Asaduzzaman Assistant Registrar, ICU, National Institute of Neurosciences Hospital, Dhaka 1207
  • Mohammad Motiul Islam Associate consultant, Asgar Ali Hospital, Dhaka 1204, Bangladesh
  • Md Sirajul Islam Assistant Professor, Dept. of Critical Care Medicine, National Institute of Neurosciences Hospital, Dhaka 1207
  • Rawshan Arra Khanam Consultant, Dept. of Pulmonary medicine. United Hospital Ltd, Dhaka 1212, Bangladesh
  • Samira Humaira Habib Principal Research Officer and Associate Professor, Health Economics Unit, Diabetic Association of Bangladesh, Dhaka 1000
  • Ashiq Haider Choudhury Research Assistant, GICU, United Hospital Ltd, Dhaka 1212, Bangladesh

DOI:

https://doi.org/10.3329/bccj.v7i2.43448

Keywords:

ICU physicians, life sustaining treatment, end of life care

Abstract

Background : This study is a sub analysis of data submitted on behalf of Bangladesh in an International study ( ACME 2012) involving physicians working in Asian ICUs.

Objective : To describe attitude of physicians of ICUs of Bangladesh toward withholding and withdrawal of life sustaining treatments in end of life care, to assess factors associated with these observations and to compare the findings especially with those of physicians of low – middle income Asian ICUs.

Method : Self-administered pre-set structured and scenario based survey conducted among 101 physicians working in 38 ICUs of Bangladesh.

Results : For patients with no real chance of recovering a meaningful life, 20 of 101 respondents reported that they almost always or often withheld life-sustaining treatments and 18 of 101 respondents almost always or often withdrew life-sustaining treatments.44 respondents in our study reported that they almost always or often withheld life sustaining treatments whereas 10 respondents almost always or often withdrew life sustaining treatments. 72% of all our respondents would implement DNR orders. In Bangladesh, religion (Islam) does not influence decision of complying with DNR order requested by family. Our study showed 71% of physicians were more likely to “do everything” if a patient with hypoxic-ischaemic encephalopathy developed septic shock. In our study, physicians were more ready to withdraw vasopressors and hemo dialysis than enteral feeding and intravenous fluids. Physicians from Bangladesh generally perceived more legal risk with limitation of life sustaining treatments because of lack of legislation for such practices. When it comes to limit aggressive lifesaving treatments, Bangladeshi physicians were less likely accede to families request to withdraw them on financial ground.

Conclusion : Like physicians of low-middle income countries of Asia, Bangladeshi ICU physicians’ self-reported practice of limiting life sustaining treatments, role of families and surrogates and perception of legal rights were significantly different than physicians of high income countries of Asia. However unlike physicians from other low income Asian countries, physicians from Bangladesh were less likely to accede to families request to withdraw life sustaining treatments on financial ground.

Bangladesh Crit Care J September 2019; 7(2): 66-72

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Published

2019-10-08

How to Cite

Faruq, M. O., Nooruzzaman, A., Tamanna, R. J., Sultana, A., Mallick, U. K., Asaduzzaman, M., Islam, M. M., Islam, M. S., Khanam, R. A., Habib, S. H., & Choudhury, A. H. (2019). Withholding and Withdrawal of Life-Sustaining Treatments in critically ill ICU patients: A study on attitude of Physicians of Bangladesh. Bangladesh Critical Care Journal, 7(2), 66–72. https://doi.org/10.3329/bccj.v7i2.43448

Issue

Vol. 7 No. 2 (2019)

Section

Original Articles

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