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Reasons, considerations, difficulties and documentation of end-of-life decisions in European intensive care units: the ETHICUS Study

Authors
Sprung, Charles L.
Woodcock, Thomas
Sjokvist, Peter
Bulow, Hans-Henrik
Lippert, Anne
Maia, Paulo
Cohen, Simon
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Published in Intensive Care Medicine. 2008, vol. 34, no. 2, p. 271-7
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.
Keywords Brain DeathCardiopulmonary Resuscitation/ethics/psychologyDecision MakingDocumentationEuropeFemaleHumansIntensive Care/ethics/methods/psychologyMalePhysician's Practice Patterns/ethicsProspective StudiesStatistics, NonparametricTerminal Care/ethics/methods/psychologyWithholding Treatment
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PMID: 17992508
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Research group Devenir des patients ayant séjourné aux soins intensifs de chirurgie (283)
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SPRUNG, Charles L. et al. Reasons, considerations, difficulties and documentation of end-of-life decisions in European intensive care units: the ETHICUS Study. In: Intensive Care Medicine, 2008, vol. 34, n° 2, p. 271-7. https://archive-ouverte.unige.ch/unige:2667

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Deposited on : 2009-09-15

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