The impact of religion on changes in end-of-life practices in European intensive care units: a comparative analysis over 16 years.

Schefold, Joerg C; Ruzzante, Livio; Sprung, Charles L; Gruber, Anastasiia; Soreide, Eldar; Cosgrove, Joseph; Mullick, Sudakshina; Papathanakos, Georgios; Koulouras, Vasilios; Maia, Paulo Azevedo; Ricou, Bara; Posch, Martin; Metnitz, Philipp; Bülow, Hans-Henrik; Avidan, Alexander (2023). The impact of religion on changes in end-of-life practices in European intensive care units: a comparative analysis over 16 years. Intensive care medicine, 49(11), pp. 1339-1348. Springer 10.1007/s00134-023-07228-z

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PURPOSE

Religious beliefs affect end-of-life practices in intensive care units (ICUs). Changes over time in end-of-life practices were not investigated regarding religions.

METHODS

Twenty-two European ICUs (3 regions: Northern, Central, and Southern Europe) participated in both Ethicus-1 (years 1999-2000) and Ethicus-2 studies (years 2015-2016). Data of ICU patients who died or had limitations of life-sustaining therapy were analysed regarding changes in end-of-life practices and patient/physician religious affiliations. Frequencies, timing of decision-making, and religious affiliations of physicians/patients were compared using the same definitions.

RESULTS

In total, 4592 adult ICU patients (n = 2807 Ethicus-1, n = 1785 Ethicus-2) were analysed. In both studies, patient and physician religious affiliations were mostly Catholic, Greek Orthodox, Jewish, Protestant, or unknown. Treating physicians (but not patients) commonly reported no religious affiliation (18%). Distribution of end-of-life practices with respect to religion and geographical regions were comparable between the two studies. Withholding [n = 1143 (40.7%) Ethicus-1 and n = 892 (50%) Ethicus-2] and withdrawing [n = 695 (24.8%) Ethicus-1 and n = 692 (38.8%) Ethicus-2] were most commonly decided. No significant changes in end-of-life practices were observed for any religion over 16 years. The number of end-of-life discussions with patients/ families/ physicians increased, while mortality and time until first decision decreased.

CONCLUSIONS

Changes in end-of-life practices observed over 16 years appear unrelated to religious affiliations of ICU patients or their treating physicians, but the effects of religiosity and/or culture could not be assessed. Shorter time until decision in the ICU and increased numbers of patient and family discussions may indicate increased awareness of the importance of end-of-life decision-making in the ICU.

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