Ethical attitudes of intensive care physicians in Hong Kong: questionnaire survey

HY Yap, GM Joynt, CD Gomersall
Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, Hong Kong

OBJECTIVES. To examine the practice and ethical attitudes of intensive care doctors in Hong Kong and to compare findings with those from European studies.

DESIGN. Structured questionnaire survey, modified from a similar questionnaire used in Europe.

SETTING. Eleven publicly funded intensive care units in Hong Kong.

PARTICIPANTS. Ninety-five doctors practising in intensive care units.

RESULTS. Of the sixty-five respondents, sizeable proportions indicated that the admission of patients to the intensive care unit is often (25%) or sometimes (51%) limited by bed availability. About 69% to 86% of doctors admit patients with limited prognosis or poor quality of life, although all felt that these admissions should be more restricted. ‘Do-not-resuscitate’ orders are applied by almost all respondents, and 52% and 89% of respondents would discuss such orders with the patient or with the family, respectively. The withholding and withdrawal of therapy from patients with no chance of recovery to a meaningful life is common in Hong Kong (99% and 89%, respectively). A total of 83% respondents involved patients or families in the decision to limit therapy, compared with less than half in Europe overall. When the family wanted aggressive life-support despite doctors’ recommendations to limit therapy, 62% of the respondents would still withhold therapy while only 9% would withdraw therapy. More than 60% of doctors feel comfortable talking to patients’ relatives about limitation of therapy. Approximately 75% felt that euthanasia is unacceptable. Most respondents (94%) reported that medical programmes should include more extensive discussion on ethical issues.

CONCLUSION. The ethical attitudes of intensive care doctors in Hong Kong are similar to those of counterparts in Europe. However, Hong Kong doctors tend to involve families more often in the discussion of end-of-life issues.

Hong Kong Med J 2004;10:244-50

Key words: Decision making; Ethics, medical; Euthanasia, passive; Intensive care units; Withholding treatment