Withholding and withdrawing life prolonging treatment in the intensive care unit: a current European perspective.
BACKGROUND
Many deaths are now preceded by an end of life decision, particularly in the intensive care unit (ICU), but such practices vary considerably between countries, ICUs and individuals, depending on many factors including cultural and religious background, family and peer pressure and local practice.


OBJECTIVE
In this review, we will discuss the application of the four key ethical principles--beneficence, nonmaleficence, autonomy and distributive justice--to withdrawing/withholding decisions.


METHODS
Drawing data from several national and international studies, we then summarize the current situation across Europe regarding such practices before making some suggestions as to how we could facilitate the often difficult decision making process by improved communication between staff, patient and relatives.
Vincent
J L
JL
Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium. jlvincen@ulb.ac.be
Berré
J
J
Creteur
J
J
D001291:Attitude of Health Personnel; D026686:Beneficence; D003142:Communication; D003422:Critical Care; D003657:Decision Making; D004992:Ethics, Medical; D005060:Europe; D008021:Life Support Systems / Q000592:standards*; D008171:Lung Diseases / Q000628:therapy; D010344:Patient Advocacy; D028761:Withholding Treatment