Forgoing life support in western European intensive care units: The results of an ethical questionnaire
Forgoing life support in western European intensive care units: The results of an ethical questionnaire
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DOI：
10.1097/00003246-199908000-00042
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发表时间：
1999-08-01
影响因子：
8.8
通讯作者：
Vincent, JL
中科院分区：
文献类型：
--
作者：
Vincent, JL
目的：为了确定目前欧洲重症监护医生对临终决策的看法，设计：向欧洲重症监护医学会的所有医生成员发送了一份问卷。结果：共504份完整的问卷，从16个西欧国家进行了分析。87%的受访者是男性。46%的受访者表示，重症监护病房的入院率通常或普遍受到床位短缺的影响，特别是在南方。尽管如此，73%的单位经常收治没有生存希望的病人，尽管只有33%的受访者认为应该收治这些病人。80%的受访者认为应该应用书面的不复苏命令，但只有58%的人这样做，根据国家的差异很大（从意大利的8%到荷兰的91%），93%的医生有时会拒绝对没有希望过上有意义生活的患者进行治疗，但停止治疗的情况并不常见，40%的受访者表示，他们会故意给这些患者服用大剂量的药物，直到死亡，49%的受访者让工作人员、患者和家人参与临终决策。45%的受访者认为道德操守咨询在这种情况下是有用的。南欧国家的医生不太可能禁止北欧国家的医生申请不复苏令，停止治疗，并与患者讨论这些问题。然而，他们更有可能重视的意见，伦理consultant.Conclusions：重症监护病房入院经常受到限制的病床在欧洲各地，特别是在南部和英国，但73%的重症监护医生仍然承认病人没有希望的生存。当治疗没有希望生存的病人时，40%的重症监护医生会故意给予大剂量的药物，直到死亡。在各种伦理问题上，医生实际做的和他或她认为应该做的之间存在着有趣的差异。欧洲国家之间在态度上也存在重大差异。
Objective: To determine current views of European intensive care physicians regarding end-of-life decisions.Design: A questionnaire was sent to all physician members of the European Society of Intensive Care Medicine. All questionnaires were anonymous.Results: A total of 504 completed questionnaires from 16 western European countries were analyzed. Eighty-seven percent of the respondents were male. Forty-six percent of respondents said that intensive care unit admissions were generally or commonly affected by bed shortages, particularly in the south. Nevertheless, 73% of units frequently admit patients with no hope of survival, although only 33% of respondents felt that such patients should be admitted. Eighty percent of respondents felt that written do-not-resuscitate orders should be applied, but only 58% did so, with a wide variation according to country (from 8% in Italy to 91% in The Netherlands), Ninety-three percent of physicians sometimes withhold treatment from patients with no hope of a meaningful life, but withdrawal of treatment is less common, Forty percent of respondents said that they would deliberately administer large doses of drugs to such patients until death ensued, Forty-nine percent of respondents involved staff, patients, and family in end-of-life decisions. Forty-five percent of respondents felt that an ethics consultation was useful in such situations. Physicians in the countries of southern Europe were less likely Ban those in the north to apply do-not-resuscitate orders, withhold treatment, and discuss such issues with the patients. However, they were more likely to value the opinion of an ethics consultant.Conclusions: Intensive care unit admissions are frequently limited by the availability of beds across Europe, particularly in the south and in the United Kingdom, yet 73% of intensivists still admit patients with no hope of survival. When treating patients with no hope of survival, 40% of intensivists will deliberately administer large doses of drugs until death ensues. There are interesting differences between what a physician actually does and what he or she believes should be done with regard to various ethical questions. Important differences in attitudes also exist between European countries.