ESAIC End-of-Life Task Force: Anaesthesiologists in end-of-life care

Anaesthesiologists play a central role in hospitals in designing clinical pathways and offering guidance in the effective management of patient care: from leading preoperative assessments and peri-operative/procedural care to delivering critical and intensive care, as well as emergency services and acute and chronic pain management.
The multidisciplinary nature of our speciality, along with a profound and global understanding, coupled with a practical and determined approach, make our speciality one of the most comprehensive and versatile in the field. This inevitably leads to a coordinated action where the safety and comfort of the patient are at the forefront.

Although it is clear that almost all aspects of the Anaesthesiologist’s care involve end-of-life decisions, it was acknowledged that ESAIC never developed any guidance documents around End-of-Life decisions. Accordingly, a Task Force (TF) that includes experts in end-of-life aspects has been formed taking into consideration different backgrounds, expertise, cultural views, geographical areas, gender and generational (including trainees) balance. The kick-off meeting took place on December 4th 2024.

We have acknowledged the lack of low risk of bias studies on this topic, thus the main purpose of the End-of-life TF is to develop an expert opinion document in which ESAIC states what the Society’s position is around end-of-life care. The outcome should also serve to be better prepared in case ESAIC is asked to support countries around End-of-Life matters in the future. Currently, no reference framework is in place.
Multiple societies have produced end-of-life care documents and guidance. The role of the ESAIC policy statement and documents will not be to “reinvent the wheel” or to focus on end-of-life care outside of spheres of anaesthetic practice. The work of the Task Force will focus on areas and scenarios where the anaesthesiologist is likely to encounter end-of-life situations which may benefit from anaesthetic input. Following the strict ESAIC quality rules for document development, pre-intra-post operative and non-operative end-of-life aspects will be analysed, and the question of how to better behave in end-of-life care offered to clinicians will be answered.

As a pan-European document, it will embrace a broad range of national and cultural views. These will include differences in national legislation as well as cultural approaches to end-of-life care. Large studies such as both ETHICUS papers have highlighted north/south and east/west differences in rates of treatment-limiting decisions, use of cardiopulmonary resuscitation, and the importance of family involvement in end-of-life care. The policy would need to focus on general ethical principles (though not necessarily Principlism) and legalities framed around the European Convention of Human Rights (ECHR) which has been incorporated into the national legislation of most European nations).
The use of language within the text is planned to be clear enough that it can give basic guidance and a “first principles” approach to end-of-life situations and avoid virtue-based language and concepts which can have ambivalent or divisive meanings to different groups.

This is only the start of this important task force. More to come and to discuss during the coming months.

Please contact task force lead: prof Edoardo De Robertis in case of questions at: guidelines@esaic.org

Authors

•  Edoardo De Robertis
• Carolina Soledad
• Paul McConnell