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Published ahead of print on January 24, 2003, doi:10.1164/rccm.200207-752OC
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American Journal of Respiratory and Critical Care Medicine Vol 167. pp. 1310-1315, (2003)
© 2003 American Thoracic Society

Discrepancies between Perceptions by Physicians and Nursing Staff of Intensive Care Unit End-of-Life Decisions

Edouard Ferrand, François Lemaire, Bernard Regnier, Khaldoun Kuteifan, Michel Badet, Pierre Asfar, Samir Jaber, Jean-Luc Chagnon, Anne Renault, René Robert, Frédéric Pochard, Christian Herve, Christian Brun-Buisson and Philippe Duvaldestin, for the French RESSENTI Group

Réanimation Chirurgicale, Hôpital Henri Mondor; Réanimation Médicale, Hôpital Universitaire Henri Mondor, AP-HP, Créteil; Laboratoire d'Ethique Médicale et de Santé Publique, Hôpital Necker Enfants-Malades; Réanimation Médicale, Hôpital Universitaire Bichat-Claude Bernard; Réanimation Médicale, Hôpital Universitaire Cochin, AP-HP, Paris; Réanimation Médicale, Hôpital La Source, Orléans; Réanimation Médicale, Hôpital Universitaire La Croix Rousse, Lyon; Réanimation Médicale, Centre Hospitalier Universitaire, Angers; Réanimation Chirurgicale, DAR B, Hôpital Universitaire Saint-Eloi, Montpellier; Réanimation Polyvalente, Centre Hospitalier Général, Valenciennes; Réanimation Médicale, Hôpital Universitaire de la Cavale Blanche, Brest; and Réanimation Médicale, Hôpital Universitaire Jean Bernard, Poitiers, France

Correspondence and requests for reprints should be addressed to Edouard Ferrand, Service d'Anesthésie-Réanimation, Unité de Réanimation Chirurgicale et Traumatologique, Hôpital Henri-Mondor, AP-HP, 51 rue du Mal de Lattre de Tassigny, 94010 Créteil cedex, France. E-mail: edouard.ferrand{at}hmn.ap-hop-paris.fr

Several studies have pointed out ethical shortcomings in the decision-making process for withholding or withdrawing life-supporting treatments. We conducted a study to evaluate the perceptions of all caregivers involved in this process in the intensive care unit. A closed-ended questionnaire was completed by 3,156 nursing staff members and 521 physicians from 133 French intensive care units (participation rate, 42%). Decision-making processes were perceived as satisfactory by 73% of physicians and by only 33% of the nursing staff. More than 90% of caregivers believed that decision-making should be collaborative, but 50% of physicians and only 27% of nursing staff members believed that the nursing staff was actually involved (p < 0.001). Fear of litigation was a reason given by physicians for modifying information given to competent patients, families, and nursing staff. Perceptions by nursing staff may be a reliable indicator of the quality of medical decision-making processes and may serve as a simple and effective tool for evaluating everyday practice. Recommendations and legislation may help to build consensus and avoid conflicts among caregivers at each step of the decision-making process.

Key Words: end-of-life decisions • ethics • decision-making • critical care • intensive care




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