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Swedish Intensive Care Physicians' Attitudes Towards Withholding or Withdrawing Life-Sustaining Treatment in
Maria Ahlerup1,2, Johan Malmgren1,3, Albert Gyllencreutz Castellheim1,2
1Department of Anaesthesiology and Intensive Care, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Swedish intensivists largely agree on end-of-life decisions for critically ill children. However, there
Area of Science:
- Pediatric Critical Care Medicine
- Medical Ethics
- End-of-Life Care Decision-Making
Background:
- Decisions regarding withholding or withdrawing life-sustaining treatments in critically ill children present significant ethical challenges.
- Understanding the perspectives of pediatric intensivists is crucial for improving end-of-life care protocols.
Purpose of the Study:
- To investigate the attitudes, values, and experiences of Swedish intensivists concerning end-of-life decision-making for critically ill children.
- To identify commonalities and variations in ethical considerations among physicians involved in pediatric intensive care.
Main Methods:
- A web-based questionnaire was distributed to 360 physicians across nine Swedish intensive care units.
- The survey focused on physicians' attitudes and experiences with end-of-life decision-making in pediatric intensive care.
- Data from 55 respondents were analyzed descriptively.
Main Results:
- 93% of physicians considered the child's wishes important or very important; 82% held the same view for guardians' wishes.
- 73% of physicians found it ethically acceptable to withdraw life-sustaining treatment against patient and guardian wishes.
- 26% of participants deemed continuing life-sustaining treatment without consent ethically acceptable.
Conclusions:
- Swedish intensivists exhibit shared attitudes on many end-of-life issues for critically ill children.
- Variability exists in physicians' views regarding the weight given to patients' and guardians' wishes.
- Further research in a Nordic context is recommended to explore these complex end-of-life decisions.
Background:
Decisions to withhold or withdraw life-sustaining treatments for critically ill children are challenging. This study aims to identify Swedish intensivists' attitudes, values and experiences towards the decision-making process concerning withholding or withdrawal of life-sustaining treatment in critically ill children.
Methods:
The nine intensive care units in Sweden that treated more than 10 children for more than 48 h during 2023 were approached. A web-based questionnaire on attitudes and experiences on end-of-life decision-making in critically ill children was distributed to the 360 physicians employed at the above-mentioned intensive care units. The results were analysed descriptively.
Results:
Fifty-five answers were retrieved. The participating physicians were experienced, 93% having personal experience with end-of-life decision-making in children. The main findings were that the child's wishes were considered important or very important by 93% of respondents. The guardians' wishes were considered important or very important by 82% of respondents. Seventy-three percent of physicians considered it ethically acceptable to withdraw life-sustaining treatment against the patients' and guardians' wishes. To continue life-sustaining treatment without the patient's and guardian's consent was considered ethically acceptable by 26% of participants.
Conclusions:
This study demonstrated that Swedish intensivists share common attitudes and values regarding most issues related to end-of-life decisions in critically ill children. However, there is variability in attitudes concerning patients' and guardians' wishes. Further studies concerning end-of-life decisions in critically ill children within a Nordic context are warranted.
Editorial Comment:
This survey study presents a sampling of views on pediatric intensive care withholding or withdrawing of treatment and from specialist physicians in one Nordic country.
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