• M Hynninen, P Klepstad, J Petersson, U Skram, and M Tallgren.
• Department of Anesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland. marja.hynninen@fimnet.fi
• Acta Anaesthesiol Scand. 2008 Sep 1;52(8):1081-5.

BackgroundHow ethical issues are dealt with varies considerably depending on the geographic and religious background of individuals. The views of Scandinavian physicians on end-of-life care were studied using a survey. The aim of this study was to clarify the actual processes of foregoing life-sustaining treatment in Scandinavia.MethodsA questionnaire was developed and sent to 78 intensive care physicians working in Denmark, Finland, Norway and Sweden.ResultsForty-four responses were obtained (13 from Denmark, eight from Finland, 12 from Norway and 11 from Sweden); 89% of the respondents were from University Hospitals. Withholding and withdrawing of treatment were practiced in all intensive care units (ICUs) concerned, but written guidelines on end-of-life care existed in only one ICU. End-of-life care is usually arranged in the ICU. Religious support is available in most hospitals during office hours, but lacking in 26% of ICUs outside office hours. Vasoactive medication, renal replacement therapy, and artificial nutrition are among the therapies most likely to be discontinued during withdrawal of life support. Certain types of monitoring and organ support are still continued in many centers during end-of-life care.ConclusionLocal written guidelines on end-of-life care are scarce in Scandinavian ICUs, which may explain the observed variability in the practices. Development of guidelines and monitoring how these instructions are carried out may help to improve the quality of care of dying ICU patients.

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