Behandeling op de IC: stoppen of doorgaan?

Endoflife decisionmaking in the Intensive Care Unit is a common and complex process. The stepbystep process of decisionmaking leading to withdrawal of lifesustaining treatment is illustrated in this paper by a clinical case. A variety of factors influences the decision to adjust the initial curative treatment policy towards withdrawal of lifesustaining therapy and the pursuit of comfort care. For a smooth decisionmaking process, it is necessary to make a prognosis and obtain consensus amongst the healthcare team. Withdrawal of lifesustaining treatment is ultimately a medical decision and a consensual decision should be reached by all medical staff and nurses, and preferably also by the patient and family. Timely involvement of a legal representative of the patient is essential for an uncomplicated decisionmaking process. Advance care planning and advance directives provide opportunities for patients to express their preferences beforehand. It is important to realise that endoflife decisions are significantly influenced by personal and cultural values.