Intensive care physicians' attitudes concerning distribution of intensive care resources - A comparison of Israeli, North American and European cohorts

Objective. To evaluate the attitudes of Israeli intensive care physicians regarding intensive care unit (ICU) triage issues. Design. An opinion survey using questionnaires similar to those used in a previous study in the United States. Setting and participants. Forty-three physicians, members of the Israel Society of Critical Care Medicine (45%). Results. Important factors for admission to the last ICU bed were: small likelihood of surviving hospitalization, irreversibility of acute disorder, nature of chronic disorders and the physician's personal attitude. Most respondents would admit a patient with a predicted survival of a few weeks (70%) or a patient whose quality of life would be poor according to the physician's (98%) or patient's (77%) definition, to the last ICU bed. The personal attitude of the respondents and their own view of the patient's quality of life were considered as important as the quality of life as viewed by the patient. Israeli physicians tended to refuse patient admission into the ICU more than their US counterparts. Most Israeli physicians refused to discharge an ICU patient in order to admit another, despite bed shortage. Conclusions. The attitudes of Israeli intensive care physicians towards distribution of ICU resources differ from those of their United States counterparts; they are more paternalistic and comply less with requests for admission. Such attitudes are comparable to those expressed by some European intensive care physicians, highlighting the existence of diversity in the factors important to physicians' decision-making.