The role of advance directives in end-of-life decisions in Austria: survey of intensive care physicians.
BACKGROUND
Currently, intensive care medicine strives to define a generally accepted way of dealing with end-of-life decisions, therapy limitation and therapy discontinuation.In 2006 a new advance directive legislation was enacted in Austria. Patients may now document their personal views regarding extension of treatment. The aim of this survey was to explore Austrian intensive care physicians' experiences with and their acceptance of the new advance directive legislation two years after enactment (2008).


METHODS
Under the aegis of the OEGARI (Austrian Society of Anaesthesiology, Resuscitation and Intensive Care) an anonymised questionnaire was sent to the medical directors of all intensive care units in Austria. The questions focused on the physicians' experiences regarding advance directives and their level of knowledge about the underlying legislation.


RESULTS
There were 241 questionnaires sent and 139 were turned, which was a response rate of 58%. About one third of the responders reported having had no experience with advance directives and only 9 directors of intensive care units had dealt with more than 10 advance directives in the previous two years. Life-supporting measures, resuscitation, and mechanical ventilation were the predominantly refused therapies, wishes were mainly expressed concerning pain therapy.


CONCLUSIONS
A response rate of almost 60% proves the great interest of intensive care professionals in making patient-oriented end-of-life decisions. However, as long as patients do not make use of their right of co-determination, the enactment of the new law can be considered only a first important step forward.
Schaden
Eva
E
Department of Anaesthesiology, General Intensive Care and Pain Management Medical University of Vienna, Austria. eva.schaden@meduniwien.ac.at
Herczeg
Petra
P
Hacker
Stefan
S
Schopper
Andrea
A
Krenn
Claus G
CG
D016223:Advance Directives / Q000331:legislation & jurisprudence / Q000639:trends; D001291:Attitude of Health Personnel; D001317:Austria; D002755:Choice Behavior; D003422:Critical Care; D003657:Decision Making; D006801:Humans; D010358:Patient Participation; D010820:Physicians / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000639:trends; D028761:Withholding Treatment / Q000639:trends; D000078329:Workforce