Discrepancies between perceptions by physicians and nursing staff of intensive care unit end-of-life decisions

Am J Respir Crit Care Med. 2003 May 15;167(10):1310-5. doi: 10.1164/rccm.200207-752OC. Epub 2003 Jan 24.


Several studies have pointed out ethical shortcomings in the decision-making process for withholding or withdrawing life-supporting treatments. We conducted a study to evaluate the perceptions of all caregivers involved in this process in the intensive care unit. A closed-ended questionnaire was completed by 3,156 nursing staff members and 521 physicians from 133 French intensive care units (participation rate, 42%). Decision-making processes were perceived as satisfactory by 73% of physicians and by only 33% of the nursing staff. More than 90% of caregivers believed that decision-making should be collaborative, but 50% of physicians and only 27% of nursing staff members believed that the nursing staff was actually involved (p < 0.001). Fear of litigation was a reason given by physicians for modifying information given to competent patients, families, and nursing staff. Perceptions by nursing staff may be a reliable indicator of the quality of medical decision-making processes and may serve as a simple and effective tool for evaluating everyday practice. Recommendations and legislation may help to build consensus and avoid conflicts among caregivers at each step of the decision-making process.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel
  • Critical Illness / therapy
  • Decision Making
  • Ethics, Medical
  • Female
  • France
  • Health Care Surveys
  • Humans
  • Intensive Care Units
  • Life Support Care / standards*
  • Life Support Care / trends
  • Logistic Models
  • Male
  • Nurse-Patient Relations
  • Physician-Patient Relations
  • Probability
  • Risk Assessment
  • Surveys and Questionnaires
  • Withholding Treatment / standards*
  • Withholding Treatment / trends