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Views of the Public and Trauma Professionals on Death and Dying From Injuries

Lenworth M. Jacobs, MD, MPH; Karyl Burns, RN, PhD; Barbara Bennett Jacobs, RN, MPH, PhD, CHPN

Arch Surg. 2008;143(8):730-735.

Objectives  To determine the values and preferences of the general public and trauma professionals regarding end-of-life care due to injury so as to inform practice guidelines.

Design, Setting, and Participants  Surveys of the general public sampled by random-digit dialing between June 6, 2005, and July 5, 2005, and of a convenience sample of trauma professionals during fall 2005 in the United States were conducted regarding preferences for care in the prehospital, emergency, and critical care settings.

Main Outcome Measures  Responses to the survey questions.

Results  Most of the public and trauma professionals would prefer palliative care when doctors determine that aggressive critical care would not be beneficial in saving their lives. During resuscitation of an injured loved one, 51.9% of the public and 62.7% of the professionals would prefer to be in the emergency department treatment room. Most of the public believes that patients should have the right to demand care not recommended by their physicians. Most of both groups trust a doctor's decision to withdraw treatment when futility is determined. More of the public (57.4%) than the professionals (19.5%) believe that divine intervention could save a person when physicians believe treatment is futile. Other findings suggest further important insights.

Conclusions  The results pose challenges that will require societal discourse to determine the best practice. Resolutions will need to be included in educational curricula and incorporated into practice to ensure that dying trauma victims and their families receive quality end-of-life care.

Author Affiliations: Department of Traumatology and Emergency Medicine (Dr Jacobs), Trauma Program (Dr Burns), and Clinical Ethics Consultation Services (Dr Bennett Jacobs), Hartford Hospital, Hartford, Connecticut; Department of Traumatology and Emergency Medicine, University of Connecticut School of Medicine, Farmington (Drs Jacobs and Burns); University of Connecticut School of Nursing, Storrs (Dr Bennett Jacobs); and Center for Clinical Bioethics, Georgetown University, Washington, DC (Dr Bennett Jacobs).

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