End-of-life decisions in Hungarian intensive care units

Abstract

Introduction: The acknowledgement of local practice with respect to endof-life decisions in accordance with laws and ethical principles is inevitable for intensive physicians in all countries. The first step for the required social dialogue is to search for local customs for harmonisation with ethical and legal regulations, as well as the interests of physicians and patients. Methods: In 2007 we performed the first Hungarian survey with the purpose to learn more about the local practice of end-of-life decisions. Questionnaires were sent out electronically to 743 registered members of the Hungarian Society of Anaesthesiology and Intensive Care. Respecting anonymity we have statistically evaluated 103 replies (response rate was 13.8%) and compared with data from other European countries. Results: As expected, it turned out from the replies that the practice of domestic intensive care physicians is very paternal and this is promoted by legal regulations that share a similar character. Intensive care physicians generally make their decisions alone (3.75/5 points) without respecting the opinion of the patient (2.57/5 points), the relatives (2.14/5 points) or other medical personnel (2.37/5 points). Furthermore they prefer not to start a therapy rather than withdraw an ongoing treatment. Nevertheless, the frequency of end-of-life decisions (3 to 9% of ICU patients) is similar to other European countries. Conclusions: Hungarian intensive care physicians make end-of-life actions routinely. They usually decide based on their own opinion, slightly considering the opinion of nursing personnel, the patients or their relatives. They are not supported by the Hungarian legal regulation in making these decisions. Although the living will and the advanced directive are both acknowledged, they are not as widespread as required. Our study is the first step to commence a social dialogue, which is taken in the evolution of end-of-life decision-making procedures.