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European attitudes towards ethical problems in intensive care medicine: Results of an ethical questionnaire

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Abstract

A questionnaire was sent to the 590 members of the European Society of Intensive Care Medicine to define both the current practices and the opinions of these specialists on various ethical issues. The answers from 242 (41%) European members were collected and analysed. The first part of the questionnaire was designed to define the criteria for admission to Intensive Care throughout Europe. Admissions to the ICU were generally or commonly limited by the number of available beds according to 57% of the respondents and sometimes or almost never according to 41% (100/242). Bed availability in the ICU was especially limited in Spain, Portugal, Italy and the United Kingdom. Despite limited bed availability, two thirds of the respondents did admit patients who were thought to have little or no hope of survival other than for a few weeks. When asked about what ought to be done in these circumstances, the number of respondents who supported the admission of such terminal patients to ICU was halved. These data illustrate the heterogeneity of admission practices in Europe and stress the need for all ICUs to define a policy for admission. The second part was designed to assess the information given to patients in the ICU. Only 24 (10%) of the respondents stated that they always delivered complete information to their patients and only 31 (13%) thought they should do so. When an iatrogenic incident occurred, only 39 (16%) claimed to relate exactly what had happened, to the patient or their relatives but 121 (50%) thought they should. Informed consent was usually reuired for surgery or gastroscopy and the administration of a new was still not required by 49 (20%) participants but the majority favored more stringent requirements (i. e. written informed consent). Most participants reported that they would accept the decision of a competent patient who wished to refuse some surgical intervention. Thus it appears that most Intensive Care doctors do aspire to respect their patients' desires and some support the principle of informed consent. However, it seems that the critically ill patient is rarely fully informed about his condition. The third part was designed to assess current attitudes towards withholding and withdrawing life support. Orders not to resuscitate (DNR orders) were frequently used but were usually verbal. 31% discussed the DNR order with the patient whereas 57% discussed it with the family. Italy was the country in which DNR orders were the least frequently used. Withholding, withdrawing life support and euthanasia were a part of the practice of 83%, 63% and 36% of respondents, respectively. The majority supported the principle of ‘limited care’. Withdrawal of all support (including intravenous fluids and feeding) was usually preferred to euthanasia. This was especially true for doctors of the Catholic falth. The entire staff of the ICU was involved in the decision to withhold/withdraw treatment according to 52% of respondents whereas 45% limited participation to the medical staff. However, some of these doctors favored the involvement of the entire staff of the ICU with the patient and/or the family in the decision making process. Only 38% felt that an Ethics Consultant (or committee) would help in this process. On occasions when the family insisted on withholding or withdrawing life support, this had little influence on the decision whereas it had a stronger effect when insisting on full support.

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This study was sponsored by the European Society of Intensive Care Medicine

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Vincent, J.L. European attitudes towards ethical problems in intensive care medicine: Results of an ethical questionnaire. Intensive Care Med 16, 256–264 (1990). https://doi.org/10.1007/BF01705162

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