title: Decision making in a life-threatening cerebral condition: a comparative study of the ethical reasoning of intensive care unit physicians and neurosurgeons.
abstract: OBJECTIVE
  To study the support for the arguments of neurosurgeons and intensive care unit (ICU) physicians for and against life-sustaining treatment of critically ill patients, and whether neurosurgeons are less inclined to emphasize quality-of-life aspects than ICU physicians.
  
  
  METHODS
  A postal questionnaire was sent to a random sample of ICU physicians in Sweden (n= 298) and all neurosurgeons in Sweden (n= 112). The respondents evaluated and prioritized different arguments for and against withholding neurosurgery, withdrawing life-sustaining treatment and providing drugs which may hasten death.
  
  
  RESULTS
  The response rate was 62.5% for neurosurgeons and 73.5% for ICU physicians. Quality-of-life aspects were stressed as an important argument by the majority of both neurosurgeons and ICU physicians (76.8% vs. 54.0%); however, significantly more neurosurgeons regarded this argument as the most important (P < 0.001). A minority in both groups, although more ICU physicians (P < 0.001), supported a patient's previously expressed wish of not ending in a persistent vegetative state as the most important argument. As the case clinically progressed, a consensus regarding the arguments for decision making evolved.
  
  
  CONCLUSIONS
  No support was found for the hypothesis that ICU physicians care more about the quality of life of a severely ill patient. Indeed, significantly more neurosurgeons emphasized the quality-of-life aspects in this particular setting. Compared with neurosurgeons, significantly more ICU physicians considered the patient's own wishes to be important.
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden. Anders.rydvall@anestesi.umu.se
authors.forename: A
authors.initials: A
authors.lastname: Rydvall
authors.forename: T
authors.initials: T
authors.lastname: Bergenheim
authors.forename: N
authors.initials: N
authors.lastname: Lynöe
mesh_terms: D001930:Brain Injuries / Q000473:pathology / Q000601:surgery*; D003657:Decision Making; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000941:ethics*; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000941:ethics*; D010820:Physicians / Q000941:ethics*