End-of-life decisions in Swedish ICUs. How do physicians from the admitting department reason?

Intensive Crit Care Nurs. 2003 Aug;19(4):241-51. doi: 10.1016/s0964-3397(03)00055-7.


Objective: To study how physicians from the admitting department reason during the decision-making process to forego life-sustaining treatment of patients in intensive care units (ICUs).

Design: Qualitative interview that applies a phenomenological approach.

Setting: Two ICUs at one secondary and one tertiary referral hospital in Sweden.

Participants: Seventeen admitting-department physicians who have participated in decisions to forego life-sustaining treatment.

Results: The decision-making process as it appeared from the physicians' experiences was complex, and different approaches to the process were observed. A pattern of five phases in the process emerged in the interviews. The physicians described the process principally as a medical one, with few ethical reflections. Decision-making was mostly done in collaboration with other physicians. Patients, family and nurses did not seem to play a significant role in the process.

Conclusion: This study describes how physicians reasoned when confronted with real patient situations in which decisions to forego life-sustaining treatment were mainly based on medical--not ethical--considerations.

MeSH terms

  • Admitting Department, Hospital
  • Decision Making*
  • Euthanasia, Passive / psychology
  • Female
  • Humans
  • Intensive Care Units
  • Life Support Care
  • Male
  • Physicians / psychology*
  • Sweden
  • Withholding Treatment*