[Survey of medical attitudes towards a "case scenario" of encephalopathy after cardiac arrest].
Recent studies have shown that the timing of death is often under the control of the physicians who treat the patient in intensive care unit (ICU), where death is commonly preceded by decisions either not to start an aggressive therapy or to discontinue life-sustaining therapy. The objective was to study end-of-life decisions and attitudes of Argentinian cardiologists when treating terminal patients in the ICU. During 2007, a survey by e-mail was carried out among 967 cardiologists across Argentina. The questionnaire consisted of the case scenario of a vegetative patient with no family and no advance directives, so the responsibility for decision making would depend exclusively on the physician or health care team. 72.7% answered the survey; 72.0% of physicians preferred to share decisions with other doctors or with an ethical committee, nevertheless they rarely involved nurses in decisions. Besides, 85.4% of cardiologists would apply the do-not-resuscitate order and 8% would choise the terminal weaning or extubation. Comparatively, these results were similar to those previously reported in Southern Europe. In conclusion, most physicians would decide with other doctors or would ask for an ethical consultant; in the same way, most of respondents would apply the do-not-resuscitate order, though a few times they would choise the terminal weaning or extubation. Since regional and international survey opinions on these issues remain highly variable, it seems difficult to reach a global consensus regarding end-of-life care in the ICU.
Comité de Bioética, Sociedad Argentina de Cardiología, 1115 Buenos Aires, Argentina.
Hernán C
HC
Doval
Raúl A
RA
Borracci
Mariano A
MA
Giorgi
Víctor
V
Darú
Eduardo
E
Tanús
Carmen
C
Núñez
D001118:Argentina; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D002309:Cardiology; D003422:Critical Care / Q000523:psychology*; D003657:Decision Making; D005260:Female; D019538:Health Care Surveys; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D008297:Male; D018458:Persistent Vegetative State / Q000209:etiology*; D016414:Resuscitation Orders / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology*; D028761:Withholding Treatment