End-of-Life Care Practices Vary Across Asia

MedicalResearch.com Interview with:
Younsuck Koh
Professor of Medicine
Professor of Medical Humanities and Social Sciences
Chairman, the Organizing Committee of the 12th World Federation of Societies of Intensive and Critical Care Medicine Congress in Seoul
Department of Pulmonary and Critical Care Medicine
Asan Medical Center, Univ. of Ulsan College of Medicine
Seoul, Korea and

Jason Phua MBBS, FRCP
National University Hospital, Singapore AVF Chairperson.
Senior Consultant & Head Division of Respiratory & Critical Care Medicine

Medical Research: What is the background for this study? What are the main findings?

Response: Provision of humane end-of-life and palliative care for dying patients and their families must remain a focus in today’s intensive care units, which continue to see technological advancements in the forms of life-sustaining measures available. End-of-life care decisions are heavily dependent on the medical, ethical, social, and cultural context. Asia, which accounts for at least half of all patients with critical illness, mechanical ventilation, and intensive care unit deaths internationally, has diverse socioeconomic conditions, cultures, and religions. Therefore, it is likely that substantial difference in the way physicians approach end-of-life care exist between Asia and the West, and among Asian countries and regions themselves. However, prior to our study, little data existed on the end-of-life care practices in this region. We found that even as end-of-life care practices in intensive care units vary significantly across Asian countries and regions, physicians in Asia generally seem less likely to limit life-sustaining treatments than their Western counterparts. Implementation of do-not-resuscitate orders are affected by multiple factors related to country or region, including economic, cultural, religious, and legal differences, as well as personal attitudes.

Medical Research: What should clinicians and patients take away from your report?

Response: While there have been calls for humane care and dignified deaths for the terminally ill, many societies in Asia have not reached a consensus on what good end-of-life care is. A thorough understanding of each country and region’s culture, its physicians’ perspectives, and its ethico-legal framework is required to improve end-of-life care practices. Importantly, we found that many Asian physicians are uncomfortable discussing end-of-life care with patients and their families. This is something healthcare professionals should urgently work on to improve the EOL care under diverse underlying conditions.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Given the striking variation in end-of-life care practices in intensive care units across Asia, further studies are needed to guide the development of best practice guidelines which may be shared between countries. Our societies urgently need this as globalization and medical advancements continue unabated.


Withholding and Withdrawal of Life-Sustaining Treatments in Intensive Care Units in Asia

Jason Phua FRCP, Gavin M. Joynt FRCP, Masaji Nishimura MD, Yiyun Deng MD, Sheila Nainan Myatra MD, Yiong Huak Chan PhD, Nguyen Gia Binh MD, Cheng Cheng Tan MBBS, Mohammad Omar Faruq MD, Yaseen M. Arabi MD, Bambang Wahjuprajitno MD, Shih-Feng Liu MD, Seyed Mohammad Reza Hashemian MD, Waqar Kashif MD, Dusit Staworn MD, Jose Emmanuel Palo MD, Younsuck Koh MD

JAMA Intern Med. 2015;175(3):-. doi:10.1001/jamainternmed.2014.7386

This study (known as the ACME study; ACME stands for Asian Collaboration for Medical Ethics) was performed by the Asian Critical Care Clinical Trials (ACCCT) Group.
Professor Younsuck Koh is the senior author for the ACME study and the Chair of the ACCCT Group

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