Perhaps religion affects physician attitudes in a less-obvious way, by being a part of the culture in which the physicians have grown up. Additional explanations that have been proposed for the lower frequency of limitation selleckchem Erlotinib of treatment in southern countries comprise the ambiguous legal context, and the absence of guidelines from national scientific societies [1,10,18-20]. Still, we found that physician reluctance to withhold or withdraw treatment did not emanate from legal concerns. It seems that, in southern Europe as well as in the Middle and Far East, the traditional belief that life must be preserved at all costs is stronger than that in northern Europe and North America [11,19-21].Despite the financial problems with which the Greek health-care system is confronted, economic cost was not proved to be a determinant of end-of-life decisions.

Similarly, notwithstanding the scarcity of ICU beds, in almost no case was life support withheld or withdrawn on the basis of resource allocation.In this study, the choice between providing full support and foregoing life-sustaining therapy was driven primarily by an evaluation of objective medical data, mainly the predicted reversibility of the underlying and acute conditions and the unresponsiveness to treatment already offered. Prognostic uncertainty contributed considerably to the decision not to withhold or withdraw life-preserving interventions, indicating physician perseverence until all hope of patient survival had vanished. When deciding to withhold or withdraw life-sustaining therapy (besides CPR), physicians seriously took into account the patient’s preexisting and future poor health.

Hence, physicians’ perception of patients’ quality of life seems to be a substantial factor in such decisions.In contrast to previous research [3,5,6,8,9,12,22], we found no association between the limitation of treatment and the patient’s age. Moreover, age was rarely cited as a factor prompting the decision to forego life support. This is an encouraging finding. It has been argued that old age alone is not a valid justification for refusing intensive care [23]. After all, the literature provides contradictory results as to whether the ICU mortality of elderly patients is significantly higher than that of young patients after adjustment for confounding factors [24-26].

Again, unlike in other studies [3,5,8,9,12,22,27], patients who received full treatment and those who underwent limitation of life-sustaining therapy did not differ in regard to the severity of illness on admission to the ICU (as measured by the APACHE II score) and the presence of comorbidities, including malignancy. Conversely, patients in whom treatment was withheld/withdrawn had a more protracted course, as reflected in Brefeldin_A their longer hospital and ICU stay, and a higher APACHE II score 24 hours before death.