, Volume 38, Issue 11, pp 1736-1737
Date: 01 Sep 2012

Time for change in culture

This is an excerpt from the content

“The only way to heal is with cold steel. A chance to cut is a chance to cure”

House of God [1].

For decades, there has been a debate over the implications and causes of the striking regional variation in end-of-life care [26]. Barnato et al. [7] conducted a mix-method case study that provides some important insights into the culture of decision-making processes in two intensive care units (ICUs) in the same healthcare system that differ in intensity of care among seriously ill patients in the ICU. In the ICU with the lower intensity of care, decision-making focused on the overall picture of the patient’s condition, as opposed to the ICU with the higher intensity of care where the focus was on a physiological parameter as the goal of care as illustrated by this quotation: “We can’t go on indefinitely. What is the end point?” with the fellow’s response: “her dry weight” [7]. My characterization of the decision-making model in the high-intensity ICU is as futility-based decision-making, i

This editorial refers to the article available at: doi:10.1007/s00134-012-2661-6.