[Limitation of treatment in a critical care unit.]

Increased medical and technical knowledge has saved the lives of more patients than was possible a few decades ago. This has also raised many ethical questions. It is now regarded to be justifiable to limit treatment for some terminally ill patients because certain treatment options are not felt to be in the patient's best interest. At The Reykjavik Hospital guidelines regarding the limitation of treatment were instituted in 1992. This study was undertaken to find out how these guidelines were implemented, how often treatment was limited, what reasons were given and how the documentation was carried out.

Included were all patients in the intensive care unit for whom treatment was limited in the year 1993. When the decision was made to limit treatment a questionnaire was filled out. Information was recorded from this and the medical record.

There were 606 patients admitted to the intensive care unit in 1993. Decisions to limit treatment were made for 25 patients (4%). The mean age was 67.6 years. The reasons for limiting treatment were neurological deficit in 15 patients, multiple organ failure in seven patients and circulatory failure in three patients. The decision to limit treatment was made most frequently by the patient's primary hospital physician after consultation with the intensive care physician on call and the patient's relatives. Twenty-two of the patients were unconscious when the decision to limit treatment was made. Twenty-one died in the intensive care unit and four were discharged to a general patient ward.

Comparing our findings with those of similar studies in other countries it was found that the decision to limit care in our institution was made less frequently and, if made occurred later in the course of the patient's care. The documentation was considered to be less than optimal in some cases.