Intensive Care Medicine

, Volume 38, Issue 7, pp 1126–1133 | Cite as

Are religion and religiosity important to end-of-life decisions and patient autonomy in the ICU? The Ethicatt study

  • Hans-Henrik Bülow
  • Charles L. Sprung
  • Mario Baras
  • Sara Carmel
  • Mia Svantesson
  • Julie Benbenishty
  • Paulo A. Maia
  • Albertus Beishuizen
  • Simon Cohen
  • Daniel Nalos



This study explored differences in end-of-life (EOL) decisions and respect for patient autonomy of religious members versus those only affiliated to that particular religion (affiliated is a member without strong religious feelings).


In 2005 structured questionnaires regarding EOL decisions were distributed in six European countries to ICUs in 142 hospital ICUs. This sub-study of the original data analyzed answers from Protestants, Catholics and Jews.


A total of 304 physicians, 386 nurses, 248 patients and 330 family members were included in the study. Professionals wanted less treatment (ICU admission, CPR, ventilator treatment) than patients and family members. Religious respondents wanted more treatment and were more in favor of life prolongation, and they were less likely to want active euthanasia than those affiliated. Southern nurses and doctors favored euthanasia more than their Northern colleagues. Three quarters of doctors and nurses would respect a competent patient’s refusal of a potentially life-saving treatment. No differences were found between religious and affiliated professionals regarding patient’s autonomy. Inter-religious differences were detected, with Protestants most likely to follow competent patients’ wishes and the Jewish respondents least likely to do so, and Jewish professionals more frequently accepting patients’ wishes for futile treatment. However, these findings on autonomy were due to regional differences, not religious ones.


Health-care professionals, families and patients who are religious will frequently want more extensive treatment than affiliated individuals. Views on active euthanasia are influenced by both religion and region, whereas views on patient autonomy are apparently more influenced by region.


End-of-life Religion Intensive care Autonomy Euthanasia 



This paper has been supported by “Region Zealand Health Sciences Research Foundation,” The European Commission contract QLG6-CT-1999-00933 grant no. 5206 from the Chief Scientist’s office of the Ministry of Health, Israel, the European Society of Intensive Care Medicine and the European Critical Care Research Network. 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.


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Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Hans-Henrik Bülow
    • 1
  • Charles L. Sprung
    • 2
  • Mario Baras
    • 3
  • Sara Carmel
    • 4
  • Mia Svantesson
    • 5
  • Julie Benbenishty
    • 2
  • Paulo A. Maia
    • 6
  • Albertus Beishuizen
    • 7
  • Simon Cohen
    • 8
  • Daniel Nalos
    • 9
  1. 1.Intensive CareHolbaek Hospital, Region ZealandHolbaekDenmark
  2. 2.Department of Anesthesiology and Critical Care MedicineHadassah Hebrew University Medical CenterJerusalemIsrael
  3. 3.Hadassah School of Public Health, Hadassah Medical CenterThe Hebrew UniversityJerusalemIsrael
  4. 4.Centre for Multidisciplinary Research in AgingBen-Gurion University of the NegevNegevIsrael
  5. 5.Centre for Health Care ResearchÖrebro University HospitalÖrebroSweden
  6. 6.Department of Intensive Care, Centro HospitalarHospital S. AntonioPortoPortugal
  7. 7.Medical CenterVU UniversityAmsterdamThe Netherlands
  8. 8.Intensive Care UnitUniversity College HospitalLondonUK
  9. 9.Krajská zdravotní a.s.ARO Masarykova nemocnice Ústí nadLabemCzech Republic

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