Withdrawal of life support – who should decide?

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Abstract
Objective: To examine the attitudes of the general public regarding who should decide about the withdrawal of life support and to compare these attitudes with those of intensive care personnel. Design: Nationwide postal questionnaire survey. Setting: Sweden. Participants: One thousand one hundred ninety-six randomly selected persons from the Swedish population register, 339 nurses and 121 physicians from 29 randomly selected intensive care units (ICUs). Measurements and results: Respondents' answers to questions related to two clinical scenarios: one with a conscious and competent patient and one with an unconscious patient. The response rates were 64 % for the general public, 86 % for the nurses and 88 % for the physicians. Concerning the competent patient, 48 % of the public, 31 % of the nurses and 8 % of the physicians were of the opinion that a decision about continued ventilator treatment should be made by the patient alone or together with the family, but without the physician. The vast majority of physicians (87 %) wanted to make the decision themselves, either alone or together with the patient or family. Concerning the incompetent patient, 73 % of the general public and 70 % of the nurses advocated a joint decision made by the family and the physician together. The majority of the physicians (61 %) regarded themselves as the sole decision-maker, a view supported by only 5 % of the public and 20 % of the nurses. Conclusions: While existing Swedish guidelines recommend that the physician should be the sole decision-maker, the general public favour more patient and family influence on the decision to withdraw life support as compared with intensive care physicians.

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