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

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.