Hadassah Leads International Study on Changing Intensive Care Practices on End-of-Life Decisions

Thursday, Oct 10 2019

Contact: Renee Young
Hadassah National Public Relations

October 10, 2019 – NEW YORK, NY  - Intensive care teams the world over deal daily with matters of life and death. To what extent  today’s medical professionals intervene to prolong life through interventions like CPR (resuscitation) and ventilators is the subject of an international study headed  by Prof. Charles Sprung, Director Emeritus of the General Intensive Care Unit and Dr. Alexander Avidan, Director of the Unit for Medical Informatics Unit at Hadassah Hospital in Jerusalem. The results of the research with 22 hospitals will appear in the October issue of the Journal of the American Medical Association (JAMA).

The research compares today’s practices with those surveyed by Prof. Sprung and colleagues 16 years ago. The report highlights the changes that have occurred in the decision-making process vis a vis withholding or withdrawing life-sustaining treatment. Today, more often than in the past, doctors will not insist on utilizing life-prolonging interventions (89.7%vs 68.3%). At the same time, an interesting result of the study showed that choosing not to use all means possible to extend life didn’t condemn a patient to death. Patients who didn’t receive life-prolonging therapies more often than expected continued to live than those followed 16 years ago.

Dr. Avidan states, “The major challenge in this study was how to collect the data from almost 200 intensive care units (ICUs) in 36 countries and all continents. The current JAMA includes results only from European ICUs). I developed an Internet platform that allowed easy and safe data entry with an user-friendly interface. Internal algorithms assured complete, logic and coherent data entry and provided immediate feedback if data entry was missing or wrong.”

Dr. Avidan provided 24/6 (without the Sabbath) support for all researchers around the world who participated voluntarily in this study. It was completed without receiving financial support. “We think that this personal and immediate support through the website and emails was one of the cornerstones of the huge success of this study,” said Dr. Avidan.

Patients who survived the ICU hospitalization without treatment limitations weren’t included in the study.  “It used to be that physicians saw death as failure,” said Prof. Sprung “They tended to use methods with limited success rates to try and prolong life. There has been more openness in discussing end-of-life issues, new laws and a change in consensus.  As time has progressed, certainly in intensive care, we realize that having a patient die isn’t failure. You do whatever you can to save patients but when a time comes where you cannot save them, giving them palliative care so they don’t suffer is extremely important not only for the patients but also the families.”

Differences were also found among regions of the continent. The team divided Europe into three regions – northern, central and southern which included Israel. In Southern European countries and Israel, ICU staff and families were more likely to opt for CPR, ventilation and other life-prolonging strategies. Doctors in Northern Europe decided more rapidly whether or not  to use therapies to extend life and were less inclined to demand the full range of life-extending interventions Although these nuances persist, all three regions follow the trend to limit life-extending interventions. 

Professor Sprung states, “The interesting discovery that withholding intervention doesn’t mean that a patient will die relieves some of the weight of the decision for families as well as hospital staff.”

Prof. Charles Sprung is a medical ethicist and a lawyer in addition to being a physician expert in intensive care. He is currently Director Emeritus of the General Intensive Care Unit in the Department of Anesthesiology and Critical Care Medicine at Hadassah Medical Organization (HMO) where he has worked for the past 20 years. He was previously Director of the Section of Critical Care Medicine at the VA Medical Center and the University of Miami for thirteen years. Prof. Sprung is Director of the Institute of Medicine, Ethics and Law at HMO. His specialties are sepsis, septic shock, pulmonary edema and ARDS, pulmonary artery catherization and blast injury and ethical issues including end-of-life, triage and mass disasters. He has published extensively in all of these areas in more than 300 original publications and 50 books or chapters.

Hadassah, the Women’s Zionist Organization of America, Inc. (HWZOA) is the largest Jewish women’s organization in the United States. With 300,000 members, associates and supporters Hadassah brings Jewish women together to effect change and advocate on critical issues such as women’s health equity and the security of Israel. Through the Hadassah Medical Organization's two hospitals, the world-renowned trauma center and the leading research facility in Jerusalem, Hadassah supports the delivery of exemplary patient care to over a million people every year. HMO serves without regard to race, religion or nationality and earned a Nobel Peace Prize nomination in 2005 for building “bridges to peace” through equality in medical treatment. For more information, visit my.hadassah.org.

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