Life Support Goals
Treatment and intervention are geared towards reversing the cause of ICU admission with aims of a cure.
Palliate, Palliative Care
While medical advances and modern medical technology are able to achieve much, there will be a time when the patient fails to respond appropriately and “Curative” goals become impossible (medical futility). At this juncture, it is reasonable to shift the aims from cure to symptom management. This is known as palliative care or palliation, where the ICU Team institute treatment to reduce troubling symptoms and stop treatment which may cause harm or discomfort. “Limitation of ICU intervention” recommended by the ICU Team may come in several forms. Euthanasia is not legal in Singapore.
Limiting or Stopping ICU Intervention
- Non-escalation or Expectant Management
In general, this means that no additional aggressive management will be taken. For example, blood pressure supporting medication will not be increased further in event of deterioration.
- Withdrawal of Artificial Life Support
This means that artificial life support (medication or machines such as the breathing machine) are stopped and nature allowed to take its course. This does not mean that care by the ICU Team stops. The ICU Team will continue to provide “palliative care” to minimize the patient’s discomfort. This course of action is ethnical and is different from “euthanasia”.
- Terminal Extubation
The breathing tube (endotracheal tube) is removed and breathing support is stopped.
- Do Not Resuscitate (DNR) or Not for Chest Compression
In general, this means that if the heart stops, resuscitative measures (such as medication or chest compression) will not be undertaken. This may be the expressed wish of the patient when he/she was well or it may be that the patient is on such high levels of medication or machine support, such that if the heart stops, resuscitative measures such as chest compression or additional medication are not likely to change the outcome. This is distinctively different from “euthanasia”.
- Euthanasia or “Mercy Killing”
This involves the deliberate ending of life of a person suffering an illness by unnatural means (such as administration of medication or poisons). While this is allowed in some countries, it is illegal in Singapore.