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Intensive Care Medicine

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01-11-2003 | Original

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

Authors: Alberto Giannini, Adriano Pessina, Enrico Maria Tacchi

Published in: Intensive Care Medicine | Issue 11/2003

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.

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Title: End-of-life decisions in intensive care units: attitudes of physicians in an Italian urban setting
Authors: Alberto Giannini
Adriano Pessina
Enrico Maria Tacchi
Publication date: 01-11-2003
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 11/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-003-1919-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Objective

Design

Setting

Participants

Measurements and results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Design

Setting

Participants

Measurements and results

Conclusions

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