Abstract

In the state of Israel there are no clear guidelines of decision-making for terminally ill patients. However, physicians do make decisions concerning life sustaining treatment. The rate of these decisions in medical wards in Israel is not known. The purpose of the study was to investigate prospectively, in a medical division, the rate of foregoing life-sustaining treatment. In addition, we wanted to find out whether or not senior physicians and families were involved in the decision-making process. The relationship of the decisions to the patients demographic and clinical characteristics was evaluated. Of 1039 patients hospitalized in 3/01, 12/01 and 1/02, the decision to forego life-sustaining treatment was taken in 8.8% of the cases. The highest rate was observed in the acute geriatric ward (23%) and the lowest in the Department of Cardiology (< 1%). Senior physicians were involved in 74% of the decision-making and the family was involved in only 29%. Age, marital status, dementia, functional state and the severity of sickness significantly affected the decision-making. However, on the basis of multi-regression analysis, only functional impairment prior to the hospitalization significantly affected the decision-making by the physician. The findings of this study support the essential need for accelerating legislation concerning decision-making for patients at the end of life. The adoption of the recommendations of the public committee on this subject, recently presented to the Minister of Health, provide legal validity to advance medical directives and may assist in ethical issues for end of life decision-making.