• Mia Svantesson, Peter Sjökvist, and Håkan Thorsén.
• Department of Anesthesia and Intensive Care, Centre for Caring Sciences, Orebro University Hospital, SE-701 85 Orebro, Sweden. mia.svantesson@orebroll.se
• Intensive Crit Care Nurs. 2003 Aug 1;19(4):241-51.

ObjectiveTo study how physicians from the admitting department reason during the decision-making process to forego life-sustaining treatment of patients in intensive care units (ICUs).DesignQualitative interview that applies a phenomenological approach.SettingTwo ICUs at one secondary and one tertiary referral hospital in Sweden.ParticipantsSeventeen admitting-department physicians who have participated in decisions to forego life-sustaining treatment.ResultsThe decision-making process as it appeared from the physicians' experiences was complex, and different approaches to the process were observed. A pattern of five phases in the process emerged in the interviews. The physicians described the process principally as a medical one, with few ethical reflections. Decision-making was mostly done in collaboration with other physicians. Patients, family and nurses did not seem to play a significant role in the process.ConclusionThis study describes how physicians reasoned when confronted with real patient situations in which decisions to forego life-sustaining treatment were mainly based on medical--not ethical--considerations.

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