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Published ahead of print on January 24, 2003, doi:10.1164/rccm.200207-752OC

Am. J. Respir. Crit. Care Med., Volume 167, Number 10, May 2003, 1310-1315

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Submitted on July 26, 2002
Accepted on January 6, 2003

Discrepancies between Perceptions by Physicians and Nursing Staff of ICU End-of-Life Decisions

Edouard Ferrand1*, Francois Lemaire2, Bernard Regnier3, Khaldoun Kuteifan4, Michel Badet5, Pierre Asfar6, Samir Jaber7, Jean-Luc Chagnon8, Anne Renault9, Rene Robert10, Frederic Pochard11, Christian Herve12, Christian Brun-Buisson2, Philippe Duvaldestin13, and the French RESSENTI Group

1 Reanimation Chirurgicale, Hopital Universitaire Henri Mondor, AP-HP, Creteil, France, Metropolitan; Laboratoire d'Ethique Medicale et de Sante Publique, Hopital Universitaire Necker Enfants Malades, AP-HP, Paris, France, Metropolitan, 2 Reanimation Medicale, Hopital Universitaire Henri Mondor, AP-HP, Creteil, France, Metropolitan, 3 Reanimation Medicale, Hopital Universitaire Bichat-Claude Bernard, AP-HP, Paris, France, Metropolitan, 4 Reanimation Medicale, Hopital La Source, Orleans, France, Metropolitan, 5 Reanimation Medicale, Hopital Universitaire La Croix Rousse, Lyon, France, Metropolitan, 6 Reanimation Medicale, Centre Hospitalier Universitaire, Angers, France, Metropolitan, 7 Reanimation Chirurgicale, DAR B, Hopital Universitaire Saint-Eloi, Montpellier, France, Metropolitan, 8 Reanimation Polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France, Metropolitan, 9 Reanimation Medicale, Hopital Universitaire de la Cavale Blanche, Brest, France, Metropolitan, 10 Reanimation Medicale, Hopital Universitaire Jean Bernard, Poitiers, France, Metropolitan, 11 Reanimation Medicale, Centre Hospitalier Universitaire Cochin, AP-HP, Paris, France, Metropolitan, 12 Laboratoire d'Ethique Medicale et de Sante Publique, Hopital Universitaire Necker Enfants Malades, AP-HP, Paris, France, Metropolitan, 13 Reanimation Chirurgicale, Hopital Universitaire Henri Mondor, AP-HP, Creteil, France, Metropolitan

* To whom correspondence should be addressed. 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 (ICU). A closed-ended questionnaire was completed by 3156 nursing staff members and 521 physicians from 133 French ICUs (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 felt that decision-making should be collaborative, but 50% of physicians and only 27% of nursing staff members felt 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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