Decisions to withhold or withdraw treatment (nontreatment decisions) become increasingly important because they have to be made more frequently and more explicitly.
This nationwide study provides information on the occurrence and background of these nontreatment decisions.
Three studies were undertaken : interviews with 405 physicians, 5197 answered questionnaires concerning deceased persons, and information about 2257 deaths collected by a prospective study.
Of all deaths, 30% appeared to be sudden and unexpected.
In 39% of all nonsudden deaths, a nontreatment decision was made.
This percentage varied by specialty (28% to 55%). Nontreatment decisions were made more often in older female patients.
The decisions were made at the explicit request of the patient (19%), after discussion with the patient or after a previous wish (22%), or without any involvement of the patient (59%). Of this last group, 87% of patients were not competent at the time of the decision.
In 24% of cases of nontreatment, life was shortened by at least a week.
Of all physicians interviewed, 56% had changed their attitude since the beginning of their practice, most of them toward more nontreatment decisions at the end of life.
Nontreatment decisions are made frequently in medical practice.
Most often the physician has to weigh medical and nonmedical burdens and benefits.
Mots-clés Pascal : Extrémité, Vie physiologique, Arrêt traitement, Abstinence, Traitement, Décision, Médecin, Exploration, Homme
Mots-clés Pascal anglais : End, Life (physiology), Withdrawal, Abstinence, Treatment, Decision, Physician, Exploration, Human
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0264558
Code Inist : 002B30A05. Création : 01/03/1996.