The impact of religion on changes in end-of-life practices in European intensive care units: a comparative analysis over 16 years
Joerg C. Schefold, Livio Ruzzante, Charles L. Sprung, Anastasiia Gruber, Eldar Søreide, J. F. Cosgrove, Sudakshina Mullick, Γεώργιος Παπαθανάκος, Vasilios Koulouras, Paulo Azevedo Maia, Bara Ricou, Martin Posch, Philipp Metnitz, Hans‐Henrik Bülow, Alexander Avidan, the ETHICUS II Study Group, Charles L. Sprung, Richard C. Bernstein, Alexander Avidan, Charles L. Sprung, Matthew Anstey, Alexander Avidan, Élie Azoulay, Julie Benbenishty, Du Bin, Deborah Cook, Randy Curtis, Charles Feldman, Christiane S. Hartog, Gavin M. Joynt, Motoshi Kainuma, Mitchell M. Levy, Raj Mani, Andrej Michalsen, Bara Ricou, Márcio Soares, Robert D. Truog, Didier Ledoux, Catherine Ingels, D Nalos, Jakob Gjedsted, Christiane S. Hartog, Spyridon Zakynthinos, C. Mathas, Γεώργιος Νάκος, Basil Koulouras, Γεώργιος Παπαθανάκος, Orsolya Miskolci, Charles L. Sprung, Alexander Avidan, Veronica de la Guardia, Andreu Farrán-Codina, Van Heerden, Martin Klein, Phillip D. Levin, Anneli Palo, Armand R. J. Girbes, Paulo Maia, Luís Bento, José Manuel Gómez García, A. Vidal Tegedor, Bara Ricou, Stephan Märsch, Joerg C. Schefold, Figen Esen, David Brealey
Abstract
PURPOSE: Religious beliefs affect end-of-life practices in intensive care units (ICUs). Changes over time in end-of-life practices were not investigated regarding religions. METHODS: Twenty-two European ICUs (3 regions: Northern, Central, and Southern Europe) participated in both Ethicus-1 (years 1999-2000) and Ethicus-2 studies (years 2015-2016). Data of ICU patients who died or had limitations of life-sustaining therapy were analysed regarding changes in end-of-life practices and patient/physician religious affiliations. Frequencies, timing of decision-making, and religious affiliations of physicians/patients were compared using the same definitions. RESULTS: In total, 4592 adult ICU patients (n = 2807 Ethicus-1, n = 1785 Ethicus-2) were analysed. In both studies, patient and physician religious affiliations were mostly Catholic, Greek Orthodox, Jewish, Protestant, or unknown. Treating physicians (but not patients) commonly reported no religious affiliation (18%). Distribution of end-of-life practices with respect to religion and geographical regions were comparable between the two studies. Withholding [n = 1143 (40.7%) Ethicus-1 and n = 892 (50%) Ethicus-2] and withdrawing [n = 695 (24.8%) Ethicus-1 and n = 692 (38.8%) Ethicus-2] were most commonly decided. No significant changes in end-of-life practices were observed for any religion over 16 years. The number of end-of-life discussions with patients/ families/ physicians increased, while mortality and time until first decision decreased. CONCLUSIONS: Changes in end-of-life practices observed over 16 years appear unrelated to religious affiliations of ICU patients or their treating physicians, but the effects of religiosity and/or culture could not be assessed. Shorter time until decision in the ICU and increased numbers of patient and family discussions may indicate increased awareness of the importance of end-of-life decision-making in the ICU.