Decision making in a life-threatening cerebral condition: a comparative study of the ethical reasoning of intensive care unit physicians and neurosurgeons.

Aim: To study the support for the arguments of neurosurgeons and intensive care unit (ICU) physicians for and against life-sustaining treatment of critically ill patients, and whether neurosurgeons are less inclined to emphasize quality-of-life aspects than ICU physicians.

Methods: A postal questionnaire was sent to a random sample of ICU physicians in Sweden (n= 298) and all neurosurgeons in Sweden (n= 112). The respondents evaluated and prioritized different arguments for and against withholding neurosurgery, withdrawing life-sustaining treatment and providing drugs which may hasten death.

Results: The response rate was 62.5% for neurosurgeons and 73.5% for ICU physicians. Quality-of-life aspects were stressed as an important argument by the majority of both neurosurgeons and ICU physicians (76.8% vs. 54.0%); however, significantly more neurosurgeons regarded this argument as the most important (P < 0.001). A minority in both groups, although more ICU physicians (P < 0.001), supported a patient's previously expressed wish of not ending in a persistent vegetative state as the most important argument. As the case clinically progressed, a consensus regarding the arguments for decision making evolved.

Conclusions: No support was found for the hypothesis that ICU physicians care more about the quality of life of a severely ill patient. Indeed, significantly more neurosurgeons emphasized the quality-of-life aspects in this particular setting. Compared with neurosurgeons, significantly more ICU physicians considered the patient's own wishes to be important.