Intensive Care Medicine

, Volume 33, Issue 10, pp 1732–1739

The importance of religious affiliation and culture on end-of-life decisions in European intensive care units

  • Charles L. Sprung
  • Paulo Maia
  • Hans-Henrik Bulow
  • Bara Ricou
  • Apostolos Armaganidis
  • Mario Baras
  • Elisabet Wennberg
  • Konrad Reinhart
  • Simon L. Cohen
  • Dietmar R. Fries
  • George Nakos
  • Lambertius G. Thijs
  • the Ethicus Study Group
Original

DOI: 10.1007/s00134-007-0693-0

Cite this article as:
Sprung, C.L., Maia, P., Bulow, HH. et al. Intensive Care Med (2007) 33: 1732. doi:10.1007/s00134-007-0693-0

Abstract

Objective

To determine the influence of religious affiliation and culture on end-of-life decisions in European intensive care units (ICUs).

Design and setting

A prospective, observational study of European ICUs was performed on consecutive patients with any limitation of therapy. Prospectively defined end-of-life practices in 37 ICUs in 17 European countries studied from 1 January 1999 to 30 June 2000 were compared for frequencies, patterns, timing, and communication by religious affiliation of physicians and patients and regions.

Results

Of the 31,417 patients 3,086 had limitations. Withholding occurred more often than withdrawing if the physician was Jewish (81%), Greek Orthodox (78%), or Moslem (63%). Withdrawing occurred more often for physicians who were Catholic (53%), Protestant (49%), or had no religious affiliation (47%). End-of-life decisions differed for physicians between regions and who had any religious affiliation vs. no religious affiliation in all three geographical regions. Median time from ICU admission to first limitation of therapy was 3.2 days but varied by religious affiliation; from 1.6 days for Protestant to 7.6 days for Greek Orthodox physicians. Median times from limitations to death also varied by physician's religious affiliation. Decisions were discussed with the families more often if the physician was Protestant (80%), Catholic (70%), had no religious affiliation (66%) or was Jewish (63%).

Conclusions

Significant differences associated with religious affiliation and culture were observed for the type of end of life decision, the times to therapy limitation and death, and discussion of decisions with patient families.

Keywords

Religious affiliation Religion Culture End of life decisions Intensive care units Ethics 

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Charles L. Sprung
    • 1
  • Paulo Maia
    • 2
  • Hans-Henrik Bulow
    • 3
  • Bara Ricou
    • 4
  • Apostolos Armaganidis
    • 5
  • Mario Baras
    • 6
  • Elisabet Wennberg
    • 7
  • Konrad Reinhart
    • 8
  • Simon L. Cohen
    • 9
  • Dietmar R. Fries
    • 10
  • George Nakos
    • 11
  • Lambertius G. Thijs
    • 12
  • the Ethicus Study Group
  1. 1.General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Medical CenterHadassah Hebrew UniversityJerusalemIsrael
  2. 2.Department of Intensive CareHospital Geral Santo AntonioPortoPortugal
  3. 3.Department of AnesthesiologyUniversity Hospital of GlostrupGlostrupDenmark
  4. 4.Department of AnesthesiologyHôpital Cantonal Universitaire de GeneveGenevaSwitzerland
  5. 5.Department of Critical CareEvangelismos HospitalAthensGreece
  6. 6.Hadassah School of Public Health, Hadassah Medical CenterHebrew UniversityJerusalemIsrael
  7. 7.Department of Anesthesia and Intensive CareSahlgrenska University HospitalGothenburgSweden
  8. 8.Department of Anesthesia and Intensive CareFriedrich Schiller UniversitätJenaGermany
  9. 9.Department of MedicineUniversity College of LondonLondonUK
  10. 10.Department for Critical Care MedicineMedical University InnsbruckInnsbruckAustria
  11. 11.Department of AnesthesiologyAro Masarykova NemocniceUsti nad LabemCzech Republic
  12. 12.Department of MedicineVU HospitalAmsterdamThe Netherlands