End-of-life decisions in intensive care units: attitudes of physicians in an Italian urban setting.
OBJECTIVE
To assess the attitudes of physicians in Milan, Italy, intensive care units (ICUs) regarding end-of-life decisions.


METHODS
Anonymous self-administered questionnaire.


METHODS
All 20 ICUs in Milan.


METHODS
Physicians employed in the ICUs.


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.
D000328:Adult; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003422:Critical Care / Q000941:ethics / Q000523:psychology*; D003657:Decision Making / Q000941:ethics; D033061:Ethics Consultation / Q000941:ethics / Q000706:statistics & numerical data; D005190:Family / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006786:Hospitals, Urban; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education / Q000941:ethics / Q000523:psychology*; D008875:Middle Aged; D015999:Multivariate Analysis; D010358:Patient Participation / Q000523:psychology; D016414:Resuscitation Orders / Q000941:ethics / Q000523:psychology; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics / Q000523:psychology*
Death and Euthanasia; Empirical Approach