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179 End-of-Life Ethical Issues: Paediatric Intensivists Differ from Non-Intensivist Paediatricians
  1. S Grosek1,
  2. M Orazem2,
  3. M Kanic2,
  4. G Vidmar3,
  5. U Groselj4
  1. 1Department of Pediatric Surgery and Intensive Care, University Medical Centre Ljubljana
  2. 2Medical Faculty, University of Ljubljana
  3. 3University Rehabilitation Institute
  4. 4University Children Hospital, Ljubljana, Slovenia

Abstract

Background Ethical issues often arise near the end-of-life (EOL) because of concerns about what is appropriate care and who should decide. Differences may exist between paediatric intensivists and non-intensivist paediatricians.

Aim The aim of study was to assess if the approach toward EOL ethical issues differ between paediatric intensivists and non-intensivist paediatricians.

Methods Questionnaire was given to intensivists working in the Slovene paediatric ICUs and to paediatricians participating at a yearly meeting on issues in critically ill child. The questionnaire was assessing the opinion about EOL ethical issues and experiences with them.

Results Twenty-four out of 30 Slovene paediatric and neonatal intensivists and 35 out of 65 non-intensivist paediatricians responded. The average ages in both groups were 42 years. Over 90% of intensivists as compared to less than a third of non-intensivists knew whom to counsel in ethical dilemmas (p=0.004). Eighty-three percent of intensivists accepted withdrawing of treatment as ethically appropriate as compared to 53% of the non-intensivists (p=0.0002). Do-not-resuscitate order was always followed by 59% of paediatric intensivists. Neither group found physician’s religious and cultural beliefs to be very important in decision-making process (69% and 66%).

Conclusions Substantial differences existed between paediatric intensivists and non-intensivis paediatrician in EOL ethical issues. Since only a third of non-intensivist paediatricians knew whom to counsel when facing an ethical dilemma and only around half of them accepting withdrawing of care as ethically appropriate, better ethical training is needed. Interestingly, neither group considered physician’s religious and cultural beliefs to be very important.

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