Relieving suffering or intentionally hastening death: where do you draw the line?

Objective: End-of-life practices vary worldwide. The objective was to demonstrate that there is no clear-cut distinction between treatments administered to relieve pain and suffering and those intended to shorten the dying process.

Design: Secondary analysis of a prospective, observational study.

Reasons, considerations, difficulties and documentation of end-of-life decisions in European intensive care units: the ETHICUS Study.

Objective: To evaluate physicians' reasoning, considerations and possible difficulties in end-of-life decision-making for patients in European intensive care units (ICUs).

Design: A prospective observational study.

Setting: Thirty-seven ICUs in 17 European countries.

Attitudes of European physicians, nurses, patients, and families regarding end-of-life decisions: the ETHICATT study.

Objective: To evaluate attitudes of Europeans regarding end-of-life decisions.

Design And Setting: Responses to a questionnaire by physicians and nurses working in ICUs, patients who survived ICU, and families of ICU patients in six European countries were compared for attitudes regarding quality and value of life, ICU treatments, active euthanasia, and place of treatment.

Measurements And Results: Questionnaires were distributed to 4,389 individuals and completed by 1,899 (43%).

Nurses' and physicians' opinions on aggressiveness of treatment for general ward patients.

The aim of this study was to evaluate agreement between nurses' and physicians' opinions regarding aggressiveness of treatment and to investigate and compare the rationales on which their opinions were based. Structured interviews regarding 714 patients were performed on seven general wards of a university hospital. The data gathered were then subjected to qualitative and quantitative analyses.

Communication of end-of-life decisions in European intensive care units.

Objective: To examine end-of-life (EOL) practices in European ICUs: who makes these decisions, how they are made, communication of these decisions and questions on communication between the physicians, nurses, patients and families.

Design: Data collected prospectively on EOL decisions facilitated by a questionnaire including EOL decision categories, geographical regions, mental competency, information about patient wishes, and discussions with patients, families and health care professionals.

Setting: 37 European ICUs in 17 countries.

DNR directives are established early in mechanically ventilated intensive care unit patients.

Purpose: Setting treatment goals in the intensive care unit (ICU) often involves resuscitation decisions. Our objective was to study the rate of establishing do-not-resuscitate (DNR) directives, determinants, and outcomes of those directives for mechanically ventilated patients.

Methods: In a multicentre observational study, we included consecutive adults with no DNR directives within 24 hr of ICU admission who were mechanically ventilated for at least 48 hr.

Clinician discomfort with life support plans for mechanically ventilated patients.

Objective: To examine the incidence and predictors of clinician discomfort with life support plans for ICU patients.

Design And Setting: Prospective cohort in 13 medical-surgical ICUs in four countries.

Patients: 657 mechanically ventilated adults expected to stay in ICU at least 72 h.

Clinician predictions of intensive care unit mortality.

Objective: Predicting outcomes for critically ill patients is an important aspect of discussions with families in the intensive care unit. Our objective was to evaluate clinical intensive care unit survival predictions and their consequences for mechanically ventilated patients.

Design: Prospective cohort study.

Influence of perceived functional and employment status on cardiopulmonary resuscitation directives.

Background: Perceptions about functional and employment status before admission to the intensive care unit (ICU) may influence how patients and clinicians make decisions about cardiopulmonary resuscitation.

Objective: To examine the relationship between cardiopulmonary resuscitation directives established within 24 hours of admission to the ICU and clinical perceptions of premorbid functional and employment status.

Design: Prospective observational study in 15 university-affiliated centers in Canada, the United States, Australia, and Sweden.

Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit.

Background: In critically ill patients who are receiving mechanical ventilation, the factors associated with physicians' decisions to withdraw ventilation in anticipation of death are unclear. The objective of this study was to examine the clinical determinants that were associated with the withdrawal of mechanical ventilation.

Methods: We studied adults who were receiving mechanical ventilation in 15 intensive care units, recording base-line physiological characteristics, daily Multiple Organ Dysfunction Scores, the patient's decision-making ability, the type of life support administered, the use of do-not-resuscitate orders, the physician's prediction of the patient's status, and the physician's perceptions of the patient's preferences about the use of life support.

End-of-life practices in European intensive care units: the Ethicus Study.

Context: While the adoption of practice guidelines is standardizing many aspects of patient care, ethical dilemmas are occurring because of forgoing life-sustaining therapies in intensive care and are dealt with in diverse ways between different countries and cultures.

Objectives: To determine the frequency and types of actual end-of-life practices in European intensive care units (ICUs) and to analyze the similarities and differences.

Design And Setting: A prospective, observational study of European ICUs.

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

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.