Critical care physicians' practices and attitudes and applicable statutes regarding withdrawal of life-sustaining therapies.
OBJECTIVE
To describe intensivist-educators' practices and opinions regarding the withdrawal of life-sustaining therapies, and to juxtapose these with applicable end-of-life statutes.


METHODS
A questionnaire was sent to critical care program directors in Connecticut, New York, Illinois, California, Florida and Texas (to examine regional variability). Statutes regarding end-of-life care were ascertained for these states.


RESULTS
Sixty-eight of 128 queried intensivists responded to the questionnaire. They reported having withdrawn life-sustaining therapies to a median of 28 patients in the previous year. Overall, respondents answered that of patients in whom they had withdrawn life-sustaining therapies, 55% were terminal, 20.5% weren't necessarily terminal but advance directives were applied to the situation and 22% weren't necessarily terminal but families requested withdrawal. The ranges of responses were highly variable (ranging from 5%-100% patients deemed terminal). All respondents agreed that withdrawal should be allowed in non-terminal conditions in which the likelihood or quality of survival would be unacceptable to the patient. Forty-eight respondents answered that advanced Alzheimer's Disease qualifies as a terminal illness. Connecticut's end-of-life statutes were unlike those in the five other states that allowed withdrawal of life-sustaining therapies based on advance directives and/or surrogates' consent. Practices of Connecticut respondents were similar to other sampled states.


CONCLUSIONS
These data suggest that Connecticut's statutes requiring that patients be deemed terminal (or permanently unconscious) before withdrawal of care are dissimilar from those in several other states. Connecticut intensivists who responded to our survey appear to practice end-of-life care that is similar to practices elsewhere.
Manthous
Constantine A
CA
Department of Internal Medicine, Bridgeport Hospital and Yale University School of Medicine, CT 06610, USA. pcmant@bpthosp.org
D024362:Advance Directive Adherence / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D003237:Connecticut; D003422:Critical Care / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010818:Practice Patterns, Physicians'; D011788:Quality of Life; D011795:Surveys and Questionnaires; D019452:Terminally Ill / Q000706:statistics & numerical data; D014481:United States; D028761:Withholding Treatment / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data