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E T Bartlett

Publications and source records attributed to E T Bartlett.

5 recordsLinked to original sources
PubMed1995

Differences between death and dying.

With so much attention being paid to the development and refinement of appropriate criteria and tests for death, little attention has been given to the broader conceptual issues having to do with its definition or with the relation of a definition to its criterion. The task of selecting the correct criterion is, however, virtually impossible without proper attention to the broader conceptual setting in which the definition operates as the key feature. All of the issues I will discuss arise because of this lack of concern with conceptual matters. Such problems as incorrectly diagnosing a patient as dead prior to the harvesting of his or her organs, defending the idea that death is reversible, and advocating a brainstem criterion of death, are all, I believe, errors that derive from this misplaced emphasis.

Brain Death↗
PubMed1994

Evaluation of a treatment limitation policy with a specific treatment-limiting order page.

BACKGROUND: Concerns about misinterpretation, misunderstanding, poor communication, and lack of documentation prompted a revision of our hospital's treatment limitation policy. The revised policy was designed to explicate do-not-resuscitate (DNR) orders, structure the use of DNR and other treatment-limiting orders in a logical and standard way, and improve communication. Use of a Specific Treatment-Limiting Order Page (STOP) was required. METHODS: To evaluate the policy's effects, we conducted (1) a prospective cohort study (involving 2733 patients) of treatment limitation practices before and after the new policy and (2) cross-sectional surveys of 58 nurses and 62 physicians. Outcome measures included documented treatment-limiting orders, documented discussions of these decisions, and deaths. Staff opinions about effects on communication and patient care were elicited. RESULTS: Rates of death (5.4% before and 5.6% after the policy; P = .80) and rates of DNR orders (9.3% vs 9.2%, P = .9) did not change. The use of the STOP enhanced the clarity of DNR orders and, among DNR patients, greatly increased the frequency of orders limiting 12 other specific treatments for conditions short of arrest. For example, before the policy, orders prohibited mechanical ventilation in 2% of DNR patients, compared with 66% after the policy (P < .001). Staff reported that the policy improved communication among health professionals, patients, and families. CONCLUSIONS: The treatment limitation policy with the STOP improved documentation and communication of treatment-limiting decisions. On the basis of our results, we offer a STOP for use and evaluation by others.

Aged↗
PubMed1985

'Do not resuscitate' orders. Incidence and implications in a medical-intensive care unit.

"Do not resuscitate" (DNR) decisions were examined in a medical intensive care unit (MICU) of a 1,000-bed hospital. Seventy-one (14%) of 506 study patients were designated DNR; nine survived hospitalization. Severity of illness, age, and prior health were predictive of DNR orders; race and socioeconomic factors were not. The DNR patients consumed more resources, both before and after DNR orders. Interventions started before DNR designation were continued in at least 76% of patients. Documented justifications of DNR decisions included poor prognosis (59%), poor quality of life (24%), and patients' wishes (15%). There were no written justifications for the DNR decisions in 30 cases (42%). Although willingness to write DNR orders in an MICU and continued active treatment of DNR patients are both reassuring in a general sense, they raise questions about the consistency of treatment plans and goals for individual patients.

Aged↗
PubMed1983

Human death and high technology: the failure of the whole-brain formulations.

Modern technology has raised questions about the definition of death, and various factors that influence public policy about declaring people dead. The widely accepted "whole-brain" definition of death is inadequate and should be replaced by a definition of "irreversible loss of consciousness and cognition." Any definition that identifies the innate ability of the organism to "integrate" itself or function "as a whole" should be rejected. The proponents of such definitions fail to provide a standard for the selection of essential sub-systems. The innate integration of vegetative functions cannot be used as the necessary and sufficient condition for life. A person without innate integration can still be alive; a dead person retaining just this function can survive as a living, mindless organism. Only cognitive functions have a spontaneity that is, in principle, irreplaceable.

Brain↗