Intensive Care Medicine

, Volume 33, Issue 1, pp 104–110 | Cite as

Attitudes of European physicians, nurses, patients, and families regarding end-of-life decisions: the ETHICATT study

  • Charles L. Sprung
  • Sara Carmel
  • Peter Sjokvist
  • Mario Baras
  • Simon L. Cohen
  • Paulo Maia
  • Albertus Beishuizen
  • Daniel Nalos
  • Ivan Novak
  • Mia Svantesson
  • Julie Benbenishty
  • Beverly Henderson
  • ETHICATT Study Group



To evaluate attitudes of Europeans regarding end-of-life decisions.

Design and setting

Responses to a questionnaire by physicians and nurses working in ICUs, patients who survived ICU, and families of ICU patients in six European countries were compared for attitudes regarding quality and value of life, ICU treatments, active euthanasia, and place of treatment.

Measurements and results

Questionnaires were distributed to 4,389 individuals and completed by 1,899 (43%). Physicians (88%) and nurses (87%) found quality of life more important and value of life less important in their decisions for themselves than patients (51%) and families (63%). If diagnosed with a terminal illness, health professionals wanted fewer ICU admissions, uses of CPR, and ventilators (21%, 8%, 10%, respectively) than patients and families (58%, 49%, 44%, respectively). More physicians (79%) and nurses (61%) than patients (58%) and families (48%) preferred being home or in a hospice if they had a terminal illness with only a short time to live.


Quality of life was more important for physicians and nurses than patients and families. More medical professionals want fewer ICU treatments and prefer being home or in a hospice for a terminal illness than patients and families.


End of life End of life decisions End-of-life care Ethics Attitudes Physicians 



This research was supported by European Commission contract QLG6-CT-1999-00933, grant no. 5206 from the Chief Scientist's Office of the Ministry of Health, Israel, and the European Society of Intensive Care Medicine. The EU Commission and other sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data or in the preparation, review, or approval of the manuscript. The ETHICATT study group included the following participants: Administrative and Scientific Coordinating Center (Israel): C. Sprung (Coordinator), J. Kabiri (Administrator), J. Benbenishty (Coordinating nurse), M. Baras (Statistician), S. Carmel (Questionnaire development, reliability, validity, and translation). Investigators were: Czech Republic: I. Novak (Charles University Hospital, Pilsen), D. Nalos (Aro Masarykova Nemonice, Usti nad Labem); Israel: C.L. Sprung, J. Benbenishty, D Moriah (Hadassah Hebrew University Medical Center, Jerusalem), S. Carmel, D Sagie (Ben-Gurion University of the Negev, Beer-Sheva); The Netherlands: B. Beishuizen, L.G. Thijs, VU Hospital, Amsterdam); Portugal: P. Maia, J.A. Pinho, P. Costa, P. Coimbra (Hospital Geral Santo Antonio, Porto); Sweden: P. Sjokvist, M. Svantesson (Orebro University Hospital, Orebro); United Kingdom: S. Cohen, B. Henderson (University College London, London)

Supplementary material

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Electronic Supplementary Material (RTF 22K)
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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Charles L. Sprung
    • 1
  • Sara Carmel
    • 2
  • Peter Sjokvist
    • 3
  • Mario Baras
    • 4
  • Simon L. Cohen
    • 5
  • Paulo Maia
    • 6
  • Albertus Beishuizen
    • 7
  • Daniel Nalos
    • 8
  • Ivan Novak
    • 9
  • Mia Svantesson
    • 10
  • Julie Benbenishty
    • 1
  • Beverly Henderson
    • 5
  • ETHICATT Study Group
    • 1
  1. 1.General Intensive Care Unit, Department of Anesthesiology and Critical Care MedicineHadassah Hebrew University Medical CenterJerusalemIsrael
  2. 2.Center for Multidisciplinary Research in Aging, and Department of Sociology of HealthBen-Gurion University of the NegevBeer ShevaIsrael
  3. 3.Department of Anesthesiology, Orebro University HospitalOrebro and Huddinge University HospitalStockholmSweden
  4. 4.Hadassah School of Public HealthHebrew University--Hadassah Medical CenterJerusalemIsrael
  5. 5.Department of MedicineUniversity College LondonLondonUK
  6. 6.Department of Intensive CareHospital Geral Santo AntonioPortoPortugal
  7. 7.Department of Intensive CareVU Medical CenterAmsterdamThe Netherlands
  8. 8.Department of Intensive CareMasarykUsti nad LabemCzech Republic
  9. 9.Department of MedicineCharles University Medical School and Teaching HospitalPilsenCzech Republic
  10. 10.Institution of Clinical MedicineOrebro UniversityOrebroSweden

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