title: Limitation of treatment at the end of life: an empirical-ethical analysis regarding the practices of physician members of the German Society for Palliative Medicine.
abstract: OBJECTIVE
  To determine the frequencies and types of limitation of medical treatment performed by physician members of the German Society for Palliative Medicine and to analyse the findings with respect to clinical and ethical aspects of end-of-life practices.
  
  
  METHODS
  Cross-sectional postal survey.
  
  
  METHODS
  Data collection via the secretary of the German Society for Palliative Medicine using the German language version of the EURELD survey instrument.
  
  
  METHODS
  All 1645 physician members of the German Society for Palliative Medicine. Main outcome measures Types and frequencies of limitation of treatment and possible determinants.
  
  
  RESULTS
  901 physicians participated in the study (response rate 55.8%). Participants reported limitation of treatment in 69.1% of cases. These decisions most often affected artificial nutrition (19%), chemotherapy (14%), antibiotics (11%) and medication other than antibiotics (11%). In the majority of eligible cases, physicians estimated the life-shortening effect of limitation of treatment to be <7 days. However, estimations differ depending on the medical measures in question. Bivariate statistical analysis indicated that withholding of treatment was performed significantly more frequently for patients aged ≥65 years (p=0.019). In addition, there were significant associations between the incidence of limitation of treatment and the different diseases reported by respondents as the underlying cause of death.
  
  
  CONCLUSIONS
  The findings of this study provide information on the current state of an ethically and clinically challenging aspect of clinical practice and can serve as a starting point for further interdisciplinary research on normative and empirical aspects of treatment decision-making at the end of life.
authors.affiliation: Institut für Medizinische Ethik und Geschichte der Medizin and History of Medicine, Ruhr-Universitaet Bochum, Malakowturm-Markstraße 258a, Bochum, Germany. jan.schildmann@rub.de
authors.forename: Jan
authors.initials: J
authors.lastname: Schildmann
authors.forename: Julia
authors.initials: J
authors.lastname: Hoetzel
authors.forename: Anne
authors.initials: A
authors.lastname: Baumann
authors.forename: Christof
authors.initials: C
authors.lastname: Mueller-Busch
authors.forename: Jochen
authors.initials: J
authors.lastname: Vollmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003657:Decision Making / Q000941:ethics*; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000941:ethics*; D018579:Patient Selection / Q000941:ethics*; D010820:Physicians / Q000941:ethics / Q000523:psychology*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics*; D055815:Young Adult