Imagine if you’re the attending on record in the ICU, and find that the federal government is investigating your care in end of life scenarios.

Pallimed discusses an article detailing that exact circumstance at a VA hospital.

Although they found no wrongdoing, they did find “significant variations with the interpretation of appropriate end of life management in the ICU, and recommended the establishment of new guidelines.”

Most doctors write for a morphine drip with the instructions “titrate for comfort.” That leaves significant room for interpretation by the nursing staff.

Can that process be standardized?

I don’t think so. There is significant enough variability in each patient’s end of life circumstance that will make it difficult for formal guidelines to be written.