The importance of religious affiliation and culture on end-of-life decisions in European intensive care units
The importance of religious affiliation and culture on end-of-life decisions in European intensive care units
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DOI：
10.1007/s00134-007-0693-0
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发表时间：
2007-10-01
影响因子：
38.9
通讯作者：
Thijs, Lambertius G.
中科院分区：
文献类型：
--
作者：
Sprung, Charles L.;Maia, Paulo;Thijs, Lambertius G.
目的：探讨宗教信仰和文化对欧洲重症监护病房（icu）患者临终决定的影响。设计和环境：一项前瞻性、观察性的欧洲icu研究对治疗有任何限制的连续患者进行了研究。从1999年1月1日至2000年6月30日，对17个欧洲国家的37个icu进行了前瞻性定义的临终实践研究，比较了医生、患者和地区的宗教信仰的频率、模式、时间和交流。结果：在31417例患者中，3086例存在局限性。如果医生是犹太人（81%）、希腊东正教徒（78%）或穆斯林（63%），不给药的情况比不给药的情况更常见。天主教徒（53%）、新教徒（49%）或无宗教信仰（47%）的医生更常退出。不同地区的医生的临终决定不同，在所有三个地理区域中，有宗教信仰的医生和没有宗教信仰的医生的临终决定也不同。从ICU入院到首次限制治疗的中位时间为3.2天，但因宗教信仰而异；从新教的1.6天到希腊东正教的7.6天。从限制到死亡的平均时间也因医生的宗教信仰而异。如果医生是新教徒（80%）、天主教徒（70%）、无宗教信仰（66%）或犹太教徒（63%），他们会更频繁地与家属讨论决定。结论：在临终决定的类型、治疗限制和死亡的时间以及与患者家属讨论决定方面，宗教信仰和文化存在显著差异。
Objective: To determine the influence of religious affiliation and culture on end-of-life decisions in European intensive care units ( ICUs). Design and setting: A prospective, observational study of European ICUs was performed on consecutive patients with any limitation of therapy. Prospectively defined endoflife practices in 37 ICUs in 17 European countries studied from 1 January 1999 to 30 June 2000 were compared for frequencies, patterns, timing, and communication by religious affiliation of physicians and patients and regions. Results: Of the 31,417 patients 3,086 had limitations. Withholding occurred more often than withdrawing if the physician was Jewish (81%), Greek Orthodox (78%), or Moslem (63%). Withdrawing occurred more often for physicians who were Catholic ( 53%), Protestant (49%), or had no religious affiliation ( 47%). End-of-life decisions differed for physicians between regions and who had any religious affiliation vs. no religious affiliation in all three geographical regions. Median time from ICU admission to first limitation of therapy was 3.2 days but varied by religious affiliation; from 1.6 days for Protestant to 7.6 days for Greek Orthodox physicians. Median times from limitations to death also varied by physician's religious affiliation. Decisions were discussed with the families more often if the physician was Protestant (80%), Catholic (70%), had no religious affiliation (66%) or was Jewish (63%). Conclusions: Significant differences associated with religious affiliation and culture were observed for the type of end of life decision, the times to therapy limitation and death, and discussion of decisions with patient families..