[Ethical aspects of intensive medicine. Results of an opinion survey].

BACKGROUND

The aim of this study was to know the opinion of the professionals (physicians and nursing staff) of intensive medicine concerning aspects such as informed consent, family participation in health care decisions, the possibility of not undertaking resuscitation manoeuvers and limiting care in determined cases, the responsibility of decision in the case of differences in opinion, and the existence of bioethical committees.

METHODS

A questionnaire with 19 questions was forwarded to which 381 professionals (183 physicians and 198 nurses) responded. Those who replied had a mean age of 36 +/- 7 years with at least one year of experience in an ICU (13 +/- 6 and 7 +/- 5 years, respectively). The male/female proportion was of 186/193 (152/30 physicians and 34/163 the nurses). The comparison of distribution study between physicians and nurses showed a level of significance of p < 0.05.

RESULTS

Ninety-nine percent of the responses opted for the existence of orders of "no resuscitation" (p = NS) and 95% accepted the limitation of therapeutic effort in predetermined cases (p = 0.02); for 90% the quality of life was a factor to be considered (p = 0.02). It was agreed that informed consent should be obtained in 88% (p = 0.0008) but 54% were of the opinion that this wish was not always carried out (p = NS). Eighty-nine percent believed that critical patients should be informed as to their situation and possibilities (p < 0.00001). In the case of patient incompetence 98% were of the opinion that the information should be given to relatives (p = NS) while only 67% believed that the family opinion may substitute that of the patient (p < 0.01) and when in doubt the last word corresponded to the physician (54%, p = NS) who may impose "best clinical judgement" (74%, p = NS) and in the case of a vital emergency consent or information may be passed over (88%, p = NS). Finally, 77% considered that informed consent cannot be given in all cases given that the mean sociocultural level of the patient does not allow comprehension (p < 0.005) and that Bioethical Hospitalary Committee are convenient or necessary (92%, p = NS).

CONCLUSIONS

The attitude towards the key ethical aspects of health care practice with respect to the critical patients is unanimous being most influenced by factors of age and religion rather than by aspects linked to professional status.