To determine the ethical and medical bases for decisions on withholding and withdrawing treatment in ICUs in Europe.
To investigate how these decisions are made, how and whether there is communication between patients, families, physicians and other staff in making these decisions.
To study which life-sustaining treatments are withheld or withdrawn and how this process takes place in the various countries.
To determine how well, or not, the principles of beneficence, non-maleficence, justice, autonomy, its limits, consent and refusal, substituted/surrogate consent, moral interests applied in the context of the different legal, ethical and religious climates in the various countries.
Major changes have occurred in the practice of medicine and today the majority of patients dying in the intensive care unit do so after the foregoing of life-sustaining treatments. There have been no large, prospective, multi-national studies of this problem and few of the published studies have been from Europe. The present project by the European Society of Intensive Care Medicine's working group on Ethics is a prospective study of end of life decision-making and life ending procedures in different European intensive care units. The study will determine who makes these decisions, whether there is communication and agreement between patients, families, physicians and staff in making these decisions, the reasons for the life-ending decisions, and finally determine the futility of intensive care for patients who are admitted with little likelihood of surviving or patients who remain in intensive care, despite the fact that physicians know they will die.
All patients admitted to several intensive care units throughout Europe will be evaluated for dying after cardio pulmonaly resuscitation, the withholding or withdrawing of life-sustaining treatments or having life ending procedures. A determination of the timing of the decisions, the decision makers agreement about the decisions, reasons for the decisions, the type of end of life decisions, the different types of treatments that are withheld or withdrawn at the end of life, and their timing to each other, whether pain relief is given and the type given at the end of life and futility will be made. This project should elucidate differences in approaches to the dying patient in different European countries. The objective data obtained will give patients, families, physicians and other health care providers important information in making difficult ethical and medical decisions. It will also provide information of what takes place in European Intensive Care Units at the end of hfe, including procedures to end life.04 04