Dissociation between the wishes of terminally ill parents and decisions by their offspring.
OBJECTIVE
To assess the attitude and factors affecting decision-making by offspring for life-sustaining measures toward their elderly terminally ill parents.


METHODS
Survey


METHODS
Acute geriatric department of a university-affiliated teaching hospital.


METHODS
108 offspring of 48 terminally ill elderly patients were interviewed.


METHODS
The attitude of offspring regarding life-sustaining measures based on a comprehensive questionnaire, administered by face-to-face interview, that included clinical, social, and religious information for each patient and social, religious, demographic, and educational information for each family member.


RESULTS
A significant majority requested the continuation of fluid, nutrition, and medication (78%, 66%, 73%, respectively). A minority of 25%-29% requested the initiation of resuscitation, mechanical ventilation, and dialysis. Active euthanasia was requested by seven offspring. Factors that significantly affected offspring's decisions were the degree of religious observance and close relationship. Approximately 50% of offspring believed they knew their parents' wishes, but most of them did not comply with the parents' wishes. The offspring's preferences for themselves differed in important aspects from the requests for their parents. The great majority stated that a family member and/or the responsible physician should be involved in the decision-making process (76% and 79%, respectively). Only 2.0% suggested the participation of an ethics committee, and the court was rejected by all.


CONCLUSIONS
Basic life-sustaining measures are requested for the terminally ill parents by most of the offspring. A significant minority even requested aggressive life-sustaining measures. The degree of religiosity and closeness of relationship influenced offspring's request most strongly.
Department of Geriatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
M
M
Sonnenblick
Y
Y
Friedlander
A
A
Steinberg
D032721:Adult Children; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003220:Conflict, Psychological; D018864:Cultural Diversity; D003657:Decision Making; D017041:Ethics Committees; D028601:Euthanasia, Active; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007599:Judaism / Q000523:psychology; D008020:Life Support Care / Q000523:psychology*; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D010287:Parent-Child Relations; D010819:Physician's Role; D011446:Prospective Studies; D035781:Siblings; D012945:Social Values; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology*; D028761:Withholding Treatment