End-of-life decisions in Swedish ICUs. How do physicians from the admitting department reason?

Full Abstract

OBJECTIVE:
To study how physicians from the admitting department reason during the decision-making process to forego life-sustaining treatment of patients in intensive care units (ICUs).

DESIGN:
Qualitative interview that applies a phenomenological approach.

SETTING:
Two ICUs at one secondary and one tertiary referral hospital in Sweden.

PARTICIPANTS:
Seventeen admitting-department physicians who have participated in decisions to forego life-sustaining treatment.RESULTS:
The decision-making process as it appeared from the physicians' experiences was complex, and different approaches to the process were observed. A pattern of five phases in the process emerged in the interviews. The physicians described the process principally as a medical one, with few ethical reflections. Decision-making was mostly done in collaboration with other physicians. Patients, family and nurses did not seem to play a significant role in the process.

CONCLUSION:
This study describes how physicians reasoned when confronted with real patient situations in which decisions to forego life-sustaining treatment were mainly based on medical--not ethical--considerations.

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Author information

Author/s: Svantesson, Mia (M); Sjökvist, Peter (P); Thorsén, Håkan (H);

Affiliation: Department of Anesthesia and Intensive Care, Centre for Caring Sciences, Orebro University Hospital, SE-701 85 Orebro, Sweden. mia.svantesson(-atsign-)orebroll.se

Journal and publication information

Publication Type: Journal Article

Journal: Intensive & critical care nursing : the official journal of the British Association of Critical Care Nurses (Intensive Crit Care Nurs), published in Scotland. (Language: eng)

Reference: 2003-Aug; vol 19 (issue 4) : pp 241-51

Dates: Created 2003/08/13; Completed 2003/10/30; Revised 2004/11/17;

PMID: 12915113, status: MEDLINE (last retrieval date: 11/6/2008)

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