• Joerg C Schefold, Livio Ruzzante, Charles L Sprung, Anastasiia Gruber, Eldar Soreide, Joseph Cosgrove, Sudakshina Mullick, Georgios Papathanakos, Vasilios Koulouras, MaiaPaulo AzevedoPAIntensive Care Department, Hospital Santo António (CHUdSA) and Instituto Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal., Bara Ricou, Martin Posch, Philipp Metnitz, Hans-Henrik Bülow, Alexander Avidan, and ETHICUS II Study Group.
• Department of Intensive Care Medicine, Inselspital, University of Bern, Bern, Switzerland. joerg.schefold@insel.ch.
• Intensive Care Med. 2023 Nov 1; 49 (11): 133913481339-1348.

PurposeReligious beliefs affect end-of-life practices in intensive care units (ICUs). Changes over time in end-of-life practices were not investigated regarding religions.MethodsTwenty-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.ResultsIn 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.ConclusionsChanges 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.© 2023. The Author(s).

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