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P Sjökvist

Publications and source records attributed to P Sjökvist.

7 recordsLinked to original sources
PubMed2001

From fact to recommendation: explicit value premises make the conclusion more convincing.

In this article we describe one way to use value premises, i.e. conceptions of what is right or wrong, good or bad, just or unjust. They may, in combination with the results from surveys on attitudes, be used to defend normative conclusions, for example changes in professional guidelines. Several ethical principles may be relevant when discussing an end-of-life decision. We use the preferences of those involved in or affected by that decision (the principle of autonomy) and the obligation to maximize benefits and minimize harm (the principle of beneficence) as value premises. To illustrate the ethical, empirical and logical issues relevant to assess normative conclusions, we present a Swedish survey of the attitudes of health care workers and the general public. In this survey, the physicians stated that they do not want the family to be the sole decision-maker, whilst the public did not want the physician to be the sole decision-maker. As a third option we propose joint decision-making regarding end-of-life decisions. This normative conclusion may be rationally discussed, not only by questioning scientific aspects of the survey, but also by critically assessing value premises (autonomy and beneficence) and the logic of the argument.

Culture↗
PubMed1999

Withdrawal of life support--who should decide? Differences in attitudes among the general public, nurses and physicians.

OBJECTIVE: To examine the attitudes of the general public regarding who should decide about the withdrawal of life support and to compare these attitudes with those of intensive care personnel. DESIGN: Nationwide postal questionnaire survey. SETTING: Sweden. PARTICIPANTS: One thousand one hundred ninety-six randomly selected persons from the Swedish population register, 339 nurses and 121 physicians from 29 randomly selected intensive care units (ICUs). MEASUREMENTS AND RESULTS: Respondents' answers to questions related to two clinical scenarios: one with a conscious and competent patient and one with an unconscious patient. The response rates were 64 % for the general public, 86 % for the nurses and 88 % for the physicians. Concerning the competent patient, 48 % of the public, 31 % of the nurses and 8 % of the physicians were of the opinion that a decision about continued ventilator treatment should be made by the patient alone or together with the family, but without the physician. The vast majority of physicians (87 %) wanted to make the decision themselves, either alone or together with the patient or family. Concerning the incompetent patient, 73 % of the general public and 70 % of the nurses advocated a joint decision made by the family and the physician together. The majority of the physicians (61 %) regarded themselves as the sole decision-maker, a view supported by only 5 % of the public and 20 % of the nurses. CONCLUSIONS: While existing Swedish guidelines recommend that the physician should be the sole decision-maker, the general public favour more patient and family influence on the decision to withdraw life support as compared with intensive care physicians.

Adult↗
PubMed1999

Should the ventilator be withdrawn? Attitudes of the general public, nurses and physicians.

In a Swedish nation-wide study, 1196 members of the general public, and 121 physicians and 339 nurses drawn from 29 intensive care units were questioned about the use of ventilator treatment for severely ill patients. Response rates were 64%, 88% and 86%, respectively. Two typical case history scenarios were presented: one describing a conscious and competent patient with pneumonia and severe cancer, and the other describing a patient who had been comatose for 1 month following head trauma. In the case of the cancer patient, 49% of the general public, 63% of the physicians and 59% of the nurses answered that they would wish that the ventilator treatment be discontinued, if they were the patient. In the case of the comatose patient, 48% of the general public, 82% of the physicians and 70% of the nurses answered that they would wish that the ventilator treatment to be discontinued, if they were a relative of the patient. Respondents own preferences, in the three groups, for life support favoured withdrawal of ventilator treatment.

Adult↗
PubMed1998

Limiting life support. Experiences with a special protocol.

BACKGROUND: Different aspects of withholding or withdrawal of life-sustaining treatment have been described in the literature. However, there are few descriptions of local policies or protocols regarding the limiting of life support. The present study describes the pattern of limiting life support in a Scandinavian intensive care unit (ICU) and the experience with a special protocol for such decisions. METHOD: Prospective study of decisions to limit life support in the ICU of a tertiary referral hospital during 1 year using a special protocol and medical records. RESULTS: A decision to limit life support was documented in the special protocol in 61/1008 (6%) of the patients and in 39/79 (49%) of the patients dying in the ICU. Poor prognosis and failure to respond to treatment were the most common reasons for foregoing life-sustaining treatment. Of the 61 patients with a special protocol, 7 survived more than 3 months. The decision was altered for 5 patients towards additional limitations and for 4 patients towards fewer or no limitations. CONCLUSION: Decisions to limit life support in the ICU are common. There is a substantial survival rate. A structured clinical protocol can be used for continuous follow-up of decisions and the decision-making process.

Adolescent↗