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

Abstract

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.

The principle of justice in patient priorities in the intensive care unit: the role of significant others: Table 1

“…This corresponds with findings from European ICU where patients’ pre-expressed wishes rarely form the basis for limiting life-prolonging treatment 3 – 5. Nurses participated only occasionally in the information and decision-making process with physicians and families, although their involvement may have strengthened the patient’s chances of passing on his values and choices.…”

“…According to the informants in our study, the patients rarely had a pre-expressed directive about decisions to limit life-prolonging treatment. This means that in ICU the families often represent the only access to the ICU patient’s lived life, preferences and values 3 – 22. However, patients had rarely spoken to their families about what they thought about treatment and care at the edge of life, and in Norway it is rather uncommon for physicians and patients to have an open dialogue about life-prolonging treatment.…”

The authors reply

“…We see consistency in our findings, from a multi-site cohort of acute lung injury patients in Baltimore, USA, with those of the Ethicus study, which surveyed intensivists in Europe (6). Specifically, we observed an increasing rate of limitations in life support when SOFA scores did not improve over multiple days in the intensive care unit.…”

Evaluating end of life practices in ten Brazilian paediatric and adult intensive care units

“…It has been demonstrated that EOL practices differ around the world depending on cultural, moral, religious, legal and medical aspects 5–16 28 29. The final decision takes time and should be obtained in a consensual manner, under an atmosphere of trust, confidence and harmony.…”