Reasons, considerations, difficulties and documentation of end-of-life decisions in European intensive care units: the ETHICUS Study |
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| Authors: | Charles L Sprung Thomas Woodcock Peter Sjokvist Bara Ricou Hans-Henrik Bulow Anne Lippert Paulo Maia Simon Cohen Mario Baras Seppo Hovilehto Didier Ledoux Dermot Phelan Elisabet Wennberg Wolfgang Schobersberger |
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| Institution: | (1) General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, P.O. Box 12000, 91120 Jerusalem, Israel;(2) Critical Care Directorate, Southampton University Hospitals NHS Trust, Southampton, UK;(3) Department of Anesthesiology, Orebro and Huddinge University Hospital, Stockholm, Sweden;(4) Department of Anesthesiology, Hopital Cantonal Universitaire de Geneve, Geneva, Switzerland;(5) Department of Anaesthesiology and Intensive Care (HHB), Holbaek Hospital, Region Zeeland, Denmark;(6) Department of Anesthesiology, Herlev University Hospital, Herlev, Denmark;(7) Department of Intensive Care, Hospital Geral Santo Antonio, Porto, Portugal;(8) Department of Medicine, University College of London, London, UK;(9) The Hebrew University – Hadassah School of Public Health, Hadassah Hebrew University Medical Center, Jerusalem, Israel;(10) Department of Anesthesiology, South Karelia Central Hospital, Lappeenranta, Finland;(11) Department of Anesthesiology and Intensive Care Medicine, University of Liege, Liege, Belgium;(12) Department of Intensive Care, Mater Hospital, University College, Dublin, Ireland;(13) Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden;(14) Division for General and Surgical Intensive Care Medicine, University Hospital Innsbruck, Innsbruck, Austria |
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| Abstract: | OBJECTIVE: To evaluate physicians' reasoning, considerations and possible difficulties in end-of-life decision-making for patients in European intensive care units (ICUs). DESIGN: A prospective observational study. SETTING: Thirty-seven ICUs in 17 European countries. PATIENTS AND PARTICIPANTS: 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. MEASUREMENTS AND RESULTS: 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. CONCLUSIONS: 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. |
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| Keywords: | Withholding treatment Physician's role Life-support care Intensive care units Europe Decision-making Reasons Difficulties Considerations |
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