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Decision making in a life‐threatening cerebral condition: a comparative study of the ethical reasoning of intensive care unit physicians and neurosurgeons
Author(s) -
Rydvall A.,
Bergenheim T.,
Lynöe N.
Publication year - 2007
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2007.01452.x
Subject(s) - medicine , intensive care unit , argument (complex analysis) , quality of life (healthcare) , life support , life support care , critically ill , intensive care , intensive care medicine , medline , neurosurgery , family medicine , nursing , psychiatry , political science , law
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.