The development and feasibility study of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic: the MUTUAL intervention.

Background: Patients still receive non-beneficial treatments when nearing the end of life. Advance care planning (ACP) interventions have shown to positively influence compliance with end of life wishes. Hospital physicians seem to miss opportunities to engage in ACP, whereas patients visiting the outpatient clinic usually have one or more chronic conditions and are at risk for medical emergencies.

[Dealing with treatment limitations during anaesthesia].

Treatment limitations may create a clinical dilemma during anaesthesia. Because mostly, pre-existing treatment limitations have been decided upon without considering the occurrence of a future medical intervention with its unique circumstances. In case treatment limitations are not reassessed prior to an intervention and a life threatening situation occurs during the intervention, a dilemma may arise between the patient's wishes and physician's actions.

[A woman with fever and a painful hip].

An immunocompromised 78-year-old woman had a painful hip and subacute fever. An abdominal CT scan revealed a diverticular sigmoid stenosis fistulating to the presacral space, with free gas in the paravertebral musculature and spinal canal. Because a deep necrotising infection was suspected, she underwent surgery and was treated with antibiotics.

[Treatment in the Intensive Care Unit: continue or withdraw?].

End-of-life decision-making in the Intensive Care Unit is a common and complex process. The step-by-step process of decision-making leading to withdrawal of life-sustaining treatment is illustrated in this paper by a clinical case. A variety of factors influences the decision to adjust the initial curative treatment policy towards withdrawal of life-sustaining therapy and the pursuit of comfort care.