Forgoing life support in western European intensive care units: The results of an ethical questionnaire

Objective: To determine current views of European intensive care physicians regarding end-of-life decisions. Design: A questionnaire was sent to all physician members of the European S ociety of Intensive Care Medicine. All questionnaires were anonymous. Results: A total of 504 completed questionnaires from 16 western European c ountries were analyzed. Eighty-seven percent of the respondents were male. Forty-six percent of respondents said that intensive care unit admissions w ere generally or commonly affected by bed shortages, particularly in the so uth. Nevertheless, 73% of units frequently admit patients with no hope of s urvival, although only 33% of respondents felt that such patients should be admitted. Eighty percent of respondents felt that written do-not-resuscita te orders should be applied, but only 58% did so, with a wide variation acc ording to country (from 8% in Italy to 91% in The Netherlands), Ninety-thre e percent of physicians sometimes withhold treatment from patients with no hope of a meaningful life, but withdrawal of treatment is less common, Fort y percent of respondents said that they would deliberately administer large doses of drugs to such patients until death ensued, Forty-nine percent of respondents involved staff, patients, and family in end-of-life decisions. Forty-five percent of respondents felt that an ethics consultation was usef ul in such situations. Physicians in the countries of southern Europe were less likely Ban those in the north to apply do-not-resuscitate orders, with hold treatment, and discuss such issues with the patients. However, they we re more likely to value the opinion of an ethics consultant. Conclusions: Intensive care unit admissions are frequently limited by the a vailability of beds across Europe, particularly in the south and in the Uni ted Kingdom, yet 73% of intensivists still admit patients with no hope of s urvival. When treating patients with no hope of survival, 40% of intensivis ts will deliberately administer large doses of drugs until death ensues. Th ere are interesting differences between what a physician actually does and what he or she believes should be done with regard to various ethical quest ions. Important differences in attitudes also exist between European countr ies.