Intensive Care Medicine

, Volume 29, Issue 11, pp 1902–1910 | Cite as

End-of-life decisions in intensive care units: attitudes of physicians in an Italian urban setting

  • Alberto Giannini
  • Adriano Pessina
  • Enrico Maria Tacchi
Original

Abstract

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.

Keywords

Intensive care Ethics Life-sustaining treatments Withdrawing treatment Withholding treatment End-of-life decisions 

Notes

Acknowledgements. This study was partly supported by the Catholic University of Milan. It was presented in part at the Third Congress of Italian Society for Bioethics and Ethical Committees, November, 2002. We thank all the physicians who completed the questionnaire; G. Casazza (Chair of Statistics, Department of Clinical Sciences "L. Sacco", University of Milan) and C. Lanzetti (Department of Sociology, Catholic University of Milan) for the statistical analysis; E. Colombetti (Centre for Bioethics, Catholic University of Milan) for helpful criticism; and D. Ward for the translation.

Supplementary material

Table 6. Results of multiple logistic regression for selected reported practices (PDF 18 KB)

table6.pdf (18 kb)
Table 6

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Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Alberto Giannini
    • 1
  • Adriano Pessina
    • 2
  • Enrico Maria Tacchi
    • 3
  1. 1.Intensive Care Unit, Department of Anaesthesia and Intensive Care,Istituti Clinici di PerfezionamentoMilanItaly
  2. 2.Centre for Bioethics, Department of Philosophy,Catholic University of MilanMilanItaly
  3. 3.Department of SociologyCatholic University of MilanMilanItaly

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