End-of-life decisions in Swedish ICUs. How do physicians from the admitting department reason?
OBJECTIVE
To study how physicians from the admitting department reason during the decision-making process to forego life-sustaining treatment of patients in intensive care units (ICUs).


METHODS
Qualitative interview that applies a phenomenological approach.


METHODS
Two ICUs at one secondary and one tertiary referral hospital in Sweden.


METHODS
Seventeen admitting-department physicians who have participated in decisions to forego life-sustaining treatment.


RESULTS
The decision-making process as it appeared from the physicians' experiences was complex, and different approaches to the process were observed. A pattern of five phases in the process emerged in the interviews. The physicians described the process principally as a medical one, with few ethical reflections. Decision-making was mostly done in collaboration with other physicians. Patients, family and nurses did not seem to play a significant role in the process.


CONCLUSIONS
This study describes how physicians reasoned when confronted with real patient situations in which decisions to forego life-sustaining treatment were mainly based on medical--not ethical--considerations.
Svantesson
Mia
M
Department of Anesthesia and Intensive Care, Centre for Caring Sciences, Orebro University Hospital, SE-701 85 Orebro, Sweden. mia.svantesson@orebroll.se
Sjökvist
Peter
P
Thorsén
Håkan
H
D000289:Admitting Department, Hospital; D003657:Decision Making; D005066:Euthanasia, Passive / Q000523:psychology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care; D008297:Male; D010820:Physicians / Q000523:psychology*; D013548:Sweden; D028761:Withholding Treatment