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Invited Commentary
June 2015

Treatment Escalation in the Intensive Care Unit Among Patients With Preexisting Treatment Limitations: Best-Laid Plans Gone Awry?

Author Affiliations
  • 1Section of Decision Sciences, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 2Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Intern Med. 2015;175(6):1026-1027. doi:10.1001/jamainternmed.2015.0378

In this issue of JAMA Internal Medicine, Hart and colleagues 1 provide, to our knowledge, the first known epidemiologic data on treatment patterns among patients admitted to the intensive care unit (ICU) with preexisting treatment limitations. Treatment limitations are explicit statements by the patient, documented in the medical record, refusing certain treatments, as is their right according to the Patient Self-determination Act of 1990.2 In a hospital context, treatment limitations most often include do not resuscitate (DNR) or do not intubate orders.

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