Document Detail

End-of-life decisions in intensive care units: attitudes of physicians in an Italian urban setting.
MedLine Citation:
PMID:  13680120     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess the attitudes of physicians in Milan, Italy, intensive care units (ICUs) regarding end-of-life decisions. DESIGN: Anonymous self-administered questionnaire. SETTING: All 20 ICUs in Milan. PARTICIPANTS: Physicians employed in the ICUs. MEASUREMENTS AND RESULTS: The response rate was 87% (225 of 259). Eighty-two percent of respondents estimated that <10% of deaths in their ICU followed foregoing treatment, whereas 6% estimated that more of 25% deaths followed foregoing treatment. Male gender, long professional experience, and activity mainly in the ICU were significantly associated with greater willingness to forego life-sustaining treatments. Eighty-nine percent of respondents said ethical consultation on end-of-life decisions was never sought; 58% said they would not respect the expressed desire of the patient to forego treatment; and 48% never noted the decision to forgo treatment on the clinical record. After a decision to withdraw treatment, 31% of physicians said they maintained ongoing treatment, but withheld CPR for cardiac arrest; 47% considered withholding and withdrawing life support were not ethically equivalent. CONCLUSIONS: Most physicians considered that most ICU deaths were not the result of deliberately foregoing life support. Although the overall trend was to intervene minimally in patients' dying, individual factors significantly influenced end-of-life decisions. Few physicians sought external ethical advice and decisions were entirely taken by the medical team. Direct involvement of family and treating physician was limited, and the expressed wishes of the patient were generally ignored.
Alberto Giannini; Adriano Pessina; Enrico Maria Tacchi
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2003-09-11
Journal Detail:
Title:  Intensive care medicine     Volume:  29     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2003 Nov 
Date Detail:
Created Date:  2003-11-10     Completed Date:  2004-02-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1902-10     Citation Subset:  E; IM    
Intensive Care Unit, Department of Anaesthesia and Intensive Care, Istituti Clinici di Perfezionamento, Via della Commenda 9, 20122, Milan, Italy.
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MeSH Terms
Attitude of Health Personnel*
Attitude to Death*
Decision Making* / ethics
Ethics Consultation / ethics,  utilization
Family / psychology
Health Knowledge, Attitudes, Practice
Hospitals, Urban
Intensive Care / ethics,  psychology*
Logistic Models
Medical Staff, Hospital / education,  ethics,  psychology*
Middle Aged
Multivariate Analysis
Patient Participation / psychology
Resuscitation Orders / ethics,  psychology
Terminal Care / ethics,  psychology*

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