Attitude of the Macedonian intensivists regarding withdrawal of therapy in intensive care patients: curriculum for policy development

Abstract

Ethical confusion regarding withdraw of therapy led to the aim of the study in which the knowledge and attitude of the Macedonian Intensive Care Unit (ICU) doctors and their impact on decision making process were assessed.

Methods: Knowledge, Attitude and Practice (KAP) study has been conducted on a national sample of 217 ICU doctors (response rate 83.87%), applying restructured EURELD 2002 questionnaire as study instrument. CHI-square test was used for cross tabulations.

Results: 103 responders were females and 79 males with mean age 40, 2 years +/- 3 y. Significant percent of the doctors didn't know what is withdraw of therapy, chi-square 34.47 (p < 0.0001) and for most there was no difference between withdraw of therapy and euthanasia, chi-square 41.482 (p < 0.0001). Most of doctors didn't have any formal training (67%) and didn't know whether they had experience with withdraw or withhold. Similarly to other countries, for significantly higher percentage of the Macedonian intensivists patient's wishes and patient autonomy have to be main criteria for decision. Significantly higher group of doctors (p < 0.0001) would prefer to leave their own advanced directives.

Conclusions: Legal principles in end of life care must be established in the country. Courts should have drawn a distinction between intentionally causing a patient's death (euthanasia) and allowing a patient to die as a result of the withdrawal of life support treatment. There is a need of additional improvement of postgraduate curriculum and continuous professional development of ICU doctors working with end-of-life patients.