Chronic Obstructive Pulmonary Disease: Ethical Considerations of Care

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Because chronic obstructive pulmonary disease (COPD) is a progressive disorder often characterized by recurrent episodes of respiratory failure, ethical dilemmas frequently arise regarding decisions to initiate mechanical ventilation in patients with COPD. Surprisingly, no statement exists from any professional organization pertaining to ethical issues unique to this patient population. In determining the potential benefits of mechanical ventilation in an individual patient with COPD, physicians should consider the outcome data from respiratory failure for this patient population in general. Multiple studies during the last 25 years indicate that sufficient numbers of patients with COPD survive for 1 to 2 years after a hospitalization for respiratory failure to warrant an overall aggressive therapeutic approach. In addition, no studies have identified any clinical features of patients with COPD-related acute respiratory failure that accurately identify those who are unlikely to benefit from intubation. Decisions regarding the withholding of support for patients with COPD and respiratory failure require joint deliberations by patients and their physicians based on timely and thoughtful communication of patients' health status and health care needs. These discussions are aided by the formulation of advance directives. Patients who are informed regarding their disease and prognosis can construct valid living wills and durable powers of attorney for health care that can guide end-of-life decision-making. Several barriers exist regarding the adoption of advance directives; physicians caring for patients with COPD can develop strategies to overcome these barriers and assist patients with their health care decisions

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