Collegiality for end-of-life decision making in the intensive care unit

Abstract

A French law about patient’s rights at end of life was published in 2005 and ratified that physicians could withdraw or withhold inappropriate life sustaining treatments and that the decision-making process (DMP) had to be collegial when the patient was not competent. A decree in 2006 stated that nurses, because of their proximity to the patients, should be involved in DMP. The term “pluridisciplinarity” is used rather than “collegiality” because of the different status and skills of the participants in DMP. In critical care medicine, interdisciplinarity includes physicians and nurses. Interdisciplinary communication in DMP is essential to guarantee that ethical aspects are not considered solely from the perspective of a single professional practice that remains medical but from a more holistic approach of the patient by nurses. Validity of each professional’s opinion should be recognized. Nurse involvement in DMP remains poor. Poor collaboration between physicians and nurses in end-of-life situation is associated with moral distress, burnout, and conflicts. Improvement in collaboration between nurses and physicians is required to promote an accomplished interdisciplinary communication in DMP at the end of life.