End-of-Life Practices in European Intensive Care Units

Context Whiletheadoptionofpracticeguidelinesisstandardizingmanyaspectsofpatientcare,ethicaldilemmasareoccurringbecauseofforgoinglife-sustainingtherapiesininten-sive care and are dealt with in diverse ways between different countries and cultures.Objectives To determine the frequency and types of actual end-of-life practices inEuropean intensive care units (ICUs) and to analyze the similarities and differences.Design and Setting A prospective, observational study of European ICUs.Participants Consecutive patients who died or had any limitation of therapy.Intervention Prospectively defined end-of-life practices in 37 ICUs in 17 Europeancountries were studied from January 1, 1999, to June 30, 2000.Main Outcome Measures Comparison and analysis of the frequencies and pat-ternsofend-of-lifecarebygeographicregionsanddifferentpatientsandprofessionals.Results Of31417patientsadmittedtoICUs,4248patients(13.5%)diedorhadalimi-tationoflife-sustainingtherapy.Ofthese,3086patients(72.6%)hadlimitationsoftreat-ments (10% of admissions). Substantial intercountry variability was found in the limita-tionsandthemannerofdying:unsuccessfulcardiopulmonaryresuscitationin20%(range,5%-48%), brain death in 8% (range, 0%-15%), withholding therapy in 38% (range,16%-70%), withdrawing therapy in 33% (range, 5%-69%), and active shortening ofthedyingprocessin2%(range,0%-19%).Shorteningofthedyingprocesswasreportedin7countries.Dosesofopioidsandbenzodiazepinesreportedforshorteningofthedyingprocesswereinthesamerangeasthoseusedforsymptomreliefinpreviousstudies.Limi-tation of therapy vs continuation of life-sustaining therapy was associated with patientage,acuteandchronicdiagnoses,numberofdaysinICU,region,andreligion(