title: The Durban World Congress Ethics Round Table Conference Report: II. Withholding or withdrawing of treatment in elderly patients admitted to the intensive care unit.
abstract: BACKGROUND
  Life-sustaining treatment (LST) limitation for elderly patients is highly controversial. In that context, it is useful to evaluate the attitudes to LST in the elderly among experienced intensive care unit (ICU) physicians with different backgrounds and cultures.
  
  
  METHODS
  A panel of 22 international ICU physicians from 13 countries responded to a questionnaire related to withholding (WH) and withdrawing (WD) LST in elderly patients using a semi-Likert scale.
  
  
  RESULTS
  Most experts disagree or strongly disagree (77%) that age should be used as the sole criterion for WH or WD LST, and almost all disagree (91%) that there should be a specific age for such decision making. However, the vast majority (91%) acknowledge that age should be an important consideration in conjunction with other factors. Disagreement for consideration of prioritizing the young over the old in normal ICU operations was reported in 68%, whereas in an emergency triage situation, disagreement dropped to 18%.
  
  
  CONCLUSIONS
  There is a consensus among ICU physicians that age cannot be the sole criterion on which health care decisions should be made. In that perspective, it is important to provide data showing that outcome differences between elderly and nonelderly patients are partly related to decisions to forgo LSTs.
authors.affiliation: Assistance Publique, Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Paris, F-75012, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France; INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France. Electronic address: bertrand.guidet@sat.aphp.fr.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
authors.affiliation: Department of Anaesthesia & Critical Care, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, eThekwini-Durban, South Africa.
authors.forename: Eric
authors.initials: E
authors.lastname: Hodgson
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Charles
authors.initials: C
authors.lastname: Feldman
authors.affiliation: Department of Anaesthesiology, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Fathima
authors.initials: F
authors.lastname: Paruk
authors.affiliation: Department of Anaesthesiology and Critical Care, The University of Queensland School of Medicine: Department of Intensive Care Medicine l Royal Brisbane and Women's Hospital, Herston, QLD 4029.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, Univ. of Ulsan College of Medicine, 388-1 Pungnap Dong Songpa Ku, Seoul, 138-736, Korea.
authors.forename: Younsuck
authors.initials: Y
authors.lastname: Koh
authors.affiliation: Dept of Intensive Care, Université Libre de Bruxelles, Erasme Univ Hospital.
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Vincent
authors.affiliation: AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine, 1 avenue Claude Vellefaux, 75010 Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.affiliation: General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, PO Box 12000, Jerusalem, Israel 91120.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Sprung
mesh_terms: D016223:Advance Directives; D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D003226:Congresses as Topic; D003422:Critical Care / Q000941:ethics*; D003657:Decision Making / Q000941:ethics*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care / Q000941:ethics; D008297:Male; D011795:Surveys and Questionnaires; D013727:Terminal Care; D014218:Triage; D028761:Withholding Treatment / Q000941:ethics*
keywords: Elderly; Ethics; Intensive care; Life-sustaining treatment