Withdrawal of life support - who should decide? Differences in attitudes among the general public, nurses and physicians

Objective: To examine the attitudes of the general public regarding who sho uld decide about the withdrawal of life support and to compare these attitu des with those of intensive care personnel. Design: Nationwide postal questionnaire survey. Setting: Sweden. Participants: One thousand one hundred ninety-six randomly selected persons from the Swedish population register, 339 nurses and 121 physicians from 2 9 randomly selected intensive care units (ICUs). Measurements and results: Respondents' answers to questions related to two clinical scenarios: one with a conscious and competent patient and one with an unconscious patient. The response rates were 64 % for the general publi c, 86 % for the nurses and 88 % for the physicians. Concerning the competen t patient, 48 % of the public, 31 % of the nurses and 8 % of the physicians were of the opinion that a decision about continued ventilator treatment s hould be made by the patient alone or together with the family, but without the physician. The vast majority of physicians (87 %) wanted to make the d ecision themselves, either alone or together with the patient or family. Co ncerning the incompetent patient, 73 % of the general public and 70 % of th e nurses advocated a joint decision made by the family and the physician to gether. The majority of the physicians (61 %) regarded themselves as the so le decision-maker, a view supported by only 5 % of the public and 20 % of t he nurses. Conclusions: While existing Swedish guidelines recommend that the physician should be the sole decisionmaker, the general public favour more patient a nd family influence on the decision to withdraw life support as compared wi th intensive care physicians.