The importance of religious affiliation and culture on end-of-life decisions in European intensive care units.
OBJECTIVE
To determine the influence of religious affiliation and culture on end-of-life decisions in European intensive care units (ICUs).


METHODS
A prospective, observational study of European ICUs was performed on consecutive patients with any limitation of therapy. Prospectively defined end-of-life practices in 37 ICUs in 17 European countries studied from 1 January 1999 to 30 June 2000 were compared for frequencies, patterns, timing, and communication by religious affiliation of physicians and patients and regions.


RESULTS
Of the 31,417 patients 3,086 had limitations. Withholding occurred more often than withdrawing if the physician was Jewish (81%), Greek Orthodox (78%), or Moslem (63%). Withdrawing occurred more often for physicians who were Catholic (53%), Protestant (49%), or had no religious affiliation (47%). End-of-life decisions differed for physicians between regions and who had any religious affiliation vs. no religious affiliation in all three geographical regions. Median time from ICU admission to first limitation of therapy was 3.2 days but varied by religious affiliation; from 1.6 days for Protestant to 7.6 days for Greek Orthodox physicians. Median times from limitations to death also varied by physician's religious affiliation. Decisions were discussed with the families more often if the physician was Protestant (80%), Catholic (70%), had no religious affiliation (66%) or was Jewish (63%).


CONCLUSIONS
Significant differences associated with religious affiliation and culture were observed for the type of end of life decision, the times to therapy limitation and death, and discussion of decisions with patient families.
Sprung
Charles L
CL
General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Medical Center, Hadassah Hebrew University, P.O. Box 12000, 91120, Jerusalem, Israel. sprung@cc.huji.ac.il
Maia
Paulo
P
Bulow
Hans-Henrik
HH
Ricou
Bara
B
Armaganidis
Apostolos
A
Baras
Mario
M
Wennberg
Elisabet
E
Reinhart
Konrad
K
Cohen
Simon L
SL
Fries
Dietmar R
DR
Nakos
George
G
Thijs
Lambertius G
LG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003466:Cultural Characteristics; D003657:Decision Making; D005060:Europe; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011446:Prospective Studies; D012067:Religion; D013727:Terminal Care / Q000523:psychology*; D028761:Withholding Treatment