Ethical issues in intensive care – a survey among Scandinavian intensivists

BackgroundCurrently, intensive care medicine strives to define a generally accepted way of dealing with end-of-life decisions, therapy limitation and therapy discontinuation.In 2006 a new advance directive legislation was enacted in Austria. Patients may now document their personal views regarding extension of treatment. The aim of this survey was to explore Austrian intensive care physicians' experiences with and their acceptance of the new advance directive legislation two years after enactment (2008).MethodsUnder the aegis of the OEGARI (Austrian Society of Anaesthesiology, Resuscitation and Intensive Care) an anonymised questionnaire was sent to the medical directors of all intensive care units in Austria. The questions focused on the physicians' experiences regarding advance directives and their level of knowledge about the underlying legislation.ResultsThere were 241 questionnaires sent and 139 were turned, which was a response rate of 58%. About one third of the responders reported having had no experience with advance directives and only 9 directors of intensive care units had dealt with more than 10 advance directives in the previous two years. Life-supporting measures, resuscitation, and mechanical ventilation were the predominantly refused therapies, wishes were mainly expressed concerning pain therapy.ConclusionA response rate of almost 60% proves the great interest of intensive care professionals in making patient-oriented end-of-life decisions. However, as long as patients do not make use of their right of co-determination, the enactment of the new law can be considered only a first important step forward.

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“…Our results are just in line with the findings of comparable studies done in the U.S. [8] and the Scandinavian region [9]. …”

Section: Discussionsupporting

confidence: 93%

The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians

et al. 2010

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“…Its incidence was studied with two studies on patients [172], [179] and two on health professionals [180], [181].…”

Section: Resultsmentioning

confidence: 99%

“…Treatment limitation was the most frequently studied topic amongst the original studies, including its incidence [179], [180], [182], [183], criteria for limiting life [172], [181], [184], [185], and ethical dilemmas surrounding decisions [180], [181], [182], [183], [185], [186], [187]. The role of nurses and physicians was examined and the effect of EoL decisions [185], [188], [189], [190].…”

Section: Resultsmentioning

confidence: 99%

Culture and End of Life Care: A Scoping Exercise in Seven European Countries

et al. 2012

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Aim Culture is becoming increasingly important in relation to end of life (EoL) care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence on cultural issues in EoL care generated in the different countries. Methods We scoped the literature for Germany, Norway, Belgium, the Netherlands, Spain, Italy and Portugal, carrying out electronic searches in 16 international and country-specific databases and handsearches in 17 journals, bibliographies of relevant papers and webpages. We analysed the literature which was unearthed, in its entirety and by type (reviews, original studies, opinion pieces) and conducted quantitative analyses for each country and across countries. Qualitative techniques generated themes and sub-themes. Results A total of 868 papers were reviewed. The following themes facilitated cross-country comparison: setting, caregivers, communication, medical EoL decisions, minority ethnic groups, and knowledge, attitudes and values of death and care. The frequencies of themes varied considerably between countries. Sub-themes reflected issues characteristic for specific countries (e.g. culture-specific disclosure in the southern European countries). The work from the seven European countries concentrates on cultural traditions and identities, and there was almost no evidence on ethnic minorities. Conclusion This scoping review is the first comparative exploration of the cultural differences in the understanding of EoL care in these countries. The diverse body of evidence that was identified on socio-cultural issues in EoL care, reflects clearly distinguishable national cultures of EoL care, with differences in meaning, priorities, and expertise in each country. The diverse ways that EoL care is understood and practised forms a necessary part of what constitutes best evidence for the improvement of EoL care in the future.

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“…The decision to admit a patient to the ICU is not only influenced by the family's wishes but also by the doctors' experience and attitudes (11,12,14,15). Our results show that not all doctors are equally responsive to the relatives' wishes regarding patient care.…”

Section: Discussionmentioning

confidence: 57%