Attitudes of intensivists to limiting therapy and end of life decision in the Czech Republic – a national study

Overview

Objective:
The purpose of the study was to obtain information about the attitudes of doctors working on ICUs in the Czech Republic to limiting therapy and end of life decisions (EOLD).

Design:
Prospective, multi-centre, observational study.

Setting:
ICUs in tertiary care hospitals.

Materials and Methods:
Questionnaires were posted to members of the Czech Society of Anaesthesiology and Intensive Care on their attitude to limiting therapy in patients admitted to ICUs.

Results:
870 posted questionnaires yielded a response rate of 26%. 90% of the physicians considered limiting therapy in terminally ill patients as acceptable, 51.4% agreed with terminal respiratory weaning and 19.1% with euthanasia. EOLD may be undertaken by the competent patients themselves. 96% of responders considered the physician as the key person in EOLD for the incompetent patient. 28.9% and 43% of physicians respectively would include the nurse and the family in the decision-making process and 36.9% of physicians would respect the family’s wishes in cases of differing opinion. During withholding therapy most physicians would agree with the maintenance of analgesia, sedation and infusion therapy. A written EOLD order was recorded in the patient chart in 73%. Lack of privacy and the absence of family members were considered a key obstacle to assuring dignified death.

Conclusion:
The study presents yet unpublished data regarding the attitude of the Czech Republic intensivists to the limitation of therapy and EOLD. Limitation of therapy was acceptable for the majority of responders whereas terminal respiratory weaning was refused by half of them. The absence of privacy and impersonal environment are the main obstacles to dignified dying in the ICU environment.

Key words:
limitation of therapy – intensive care