Reasons, considerations, difficulties and documentation of end-of-life decisions in European intensive care units: the ETHICUS Study
- 9 November 2007
- journal article
- research article
- Published by Springer Science and Business Media LLC in Intensive Care Medicine
- Vol. 34 (2), 271-277
- https://doi.org/10.1007/s00134-007-0927-1
Abstract
To evaluate physicians' reasoning, considerations and possible difficulties in end-of-life decision-making for patients in European intensive care units (ICUs). A prospective observational study. Thirty-seven ICUs in 17 European countries. A total of 3,086 patients for whom an end-of-life decision was taken between January 1999 and June 2000. The dataset excludes patients who died after attempts at cardiopulmonary resuscitation and brain-dead patients. Physicians indicated which of a pre-determined set of reasons for, considerations in, and difficulties with end-of-life decision-making was germane in each case as it arose. Overall, 2,134 (69%) of the decisions were documented in the medical record, with inter-regional differences in documentation practice. Primary reasons given by physicians for the decision mostly concerned the patient's medical condition (79%), especially unresponsive to therapy (46%), while chronic disease (12%), quality of life (4%), age (2%) and patient or family request (2%) were infrequent. Good medical practice (66%) and best interests (29%) were the commonest primary considerations reported, while resource allocation issues such as cost effectiveness (1%) and need for an ICU bed (0%) were uncommon. Living wills were considered in only 1% of cases. Physicians in central Europe reported no significant difficulty in 81% of cases, while in northern and southern regions there was no difficulty in 92–93% of cases. European ICU physicians do not experience difficulties with end-of-life decisions in most cases. Allocation of limited resources is a minor consideration and autonomous choices by patient or family remain unusual. Inter-regional differences were found.Keywords
This publication has 43 references indexed in Scilit:
- The impact of regional culture on intensive care end of life decision making: an Israeli perspective from the ETHICUS studyJournal of Medical Ethics, 2006
- On the difficulty of neurosurgical end of life decisionsJournal of Medical Ethics, 2006
- Interhospital variability in satisfaction with withdrawal of life support: Room for improvement?Critical Care Medicine, 2003
- Forgoing life support in western European intensive care unitsCritical Care Medicine, 1999
- Withdrawal and withholding of life support in the intensive care unit: A comparison of teaching and community hospitalsCritical Care Medicine, 1998
- Limiting life supportActa Anaesthesiologica Scandinavica, 1998
- Decisions to forego life-sustaining treatment and the duty of documentationIntensive Care Medicine, 1996
- Withholding and withdrawing life-sustaining therapy in a Canadian intensive care unitCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 1995
- Canging patterns of terminal care management in an intensive care unitCritical Care Medicine, 1994
- Intensive care: situations of ethical difficultyJournal of Advanced Nursing, 1993