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Minerva Medicolegale 2007 September;127(3):215-23


language: Italian

Comparison of Austrian and Italian Critical Care Societies’ Guidelines on therapy limitation and therapy discontinuation in intensive care units

Wiedermann B. J. 1, Druml W. 2, Steltzer H. 3, Druml C. 4, Valentin A. 5

1 Unità di Medicina II Dipartimento di Medicina Interna Ospedale Centrale di Bolzano, Bolzano, Italy 2 Division of Nephrology and Dialysis Department of Internal Medicine III Medical University of Vienna, Vienna, Austria 3 Department of Anethesia and Intensive Care Medicine Medical University of Vienna, Vienna, Austria 4 Ethics Commission Medical University of Vienna, Vienna, Austria 5 Second Medical Department KA Rudolfstiftung, Vienna, Austria


There is a wide consensus among physicians about the most difficult contexts for decision making in withholding or withdrawing treatment, admission to intensive care unit (ICU) or triage and active ending of life. There is no consensus about who should be responsible for the decision in complicated cases. The opinion of the Austrian associations of critical care medicine is that establishing committees in hospitals to reach decisions regarding therapy limitations is not to be recommended; decisions on therapy limitation and discontinuation are to be reached in the majority of cases on the basis of medical facts; should there be the need for an additional opinion from a physician regarding a decision on therapy limitation, it is advised to rely on the expertise of other physicians with experience in critical care medicine. The Italian guidelines recommend for cases where no consensual decision has been reached to rely on institutional help by ethics commissions or review boards in order to assure ethical correctness and to facilitate the decisional process. This direct comparison of two national guidelines in Europe underlines significant differences. It may be worthwhile to reconsider the usefulness of the ethics commission’s involvement in the decisional process for terminal patients receiving intensive care.

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