JL: Ethical principles in end-of-life decisions in different European countries. Swiss Med Wkly 2004, 134:65-68. Graaff et al

Many hospital deaths are now preceded by an end-of-life decision [1], particularly in the intensive care unit (ICU) [2–5]. Such decisions are often complex and will be influenced by a host of uncon-trolled factors including personal beliefs, cultural and religious influences, peer and family pressure, etc. The “taboo ” nature of death and the sensitive quality of such decisions has for many years hin-dered research, but more data are now becoming available as these issues are increasingly recognised and discussed. Recommendations on end-of-life care have been published in the US [6] and by some national intensive care societies including the UK and Switzerland [7, 8] but considerable variations exist in such practices at the national and inter-national levels. The majority of ICU deaths are preceded by a decision to limit treatment in some way. Decisions to withhold or withdraw treatment vary consider-ably depending on many factors including local practice, cultural and religious background, family and peer pressure. Here we will discuss the current situation across Europe, based on the findings from three large international studies Key words: intensive care; religion; withdrawing; withholdin