A Survey regarding Physician Preferences in End-of-Life Practices in Intensive Care across Scotland
Despite the large proportion of intensive care patients whose care is ultimately terminal, there is a lack of evidence to support best clinical practice caring for these patients. Ninety-seven consultants covering intensive care day sessions across Scotland were invited to take part in a web-based questionnaire. Fifty-eight respondents (60%) completed the questionnaire. Non-escalation of therapy and abrupt withdrawal appear to be the preferred methods of limiting treatment at the end of life. This was achieved most commonly by a reduction in FiO 2 and cessation of inotropic support. Extubation was not favoured, with only four respondents claiming it as routine practice. Practical efforts made to determine futility appear to be made by at least two intensive care consultants. Of respondents, 24% consider non-escalation of treatment and active withdrawal to be ethically different and 15% held the view that there was moral equivalence between withdrawing treatment and the active shortening of the dying process. There are wide variations in clinician preferences for the methods used to limit treatment at the end of life. Consensus, therefore, may prove to be a challenge to achieve.