Withdrawal of life-sustaining treatment; decision-making; disorders of consciousness; do-not-resuscitation orders; ethics; Humans; Male; China; Female; Adult; Middle Aged; Surveys and Questionnaires; Terminal Care/ethics; Terminal Care/psychology; Resuscitation Orders/ethics; Attitude of Health Personnel; Aged; Young Adult; Withholding Treatment/ethics; Decision Making/ethics; Consciousness Disorders/therapy; Consciousness Disorders; Decision Making; Resuscitation Orders; Terminal Care; Withholding Treatment; Medicine (all)
Abstract :
[en] [en] OBJECTIVES: We aim to investigate the ethical attitudes of the Chinese population toward withdrawal of life-sustaining treatment (WLST) in disorders of consciousness (DoC) patients.
METHODS: A self-administered questionnaire concerning WLST was distributed to Chinese medical professionals and non-medical participants between February and July 2022. Statistical analysis included chi-square tests and logistic regressions.
RESULTS: A total of 1223 Chinese participants responded to the questionnaire (39% of whom were medical professionals). Less than one third of participants reported positive attitudes towards withdrawing artificial nutrition and hydration (ANH), antibiotics, and do-not-resuscitation (DNR) orders in patients with unresponsive wakefulness syndrome (UWS) (30%, 24%, 24%) and minimally conscious state (MCS) (23%, 19%, 15%). More respondents agreed with WLST in UWS compared to MCS (p < 0.05). Positive attitudes toward DNR orders were associated with participants' older age, religion, monthly income > 5000 RMB and medical profession (p < 0.05). Most participants deemed patient's will (78%), families' wishes (67%), and financial burden (63%) to be crucial factors when considering WLST.
CONCLUSIONS: Chinese respondents exhibit a relatively low propensity to accept WLST in DoC. Ethical attitudes toward WLST resulted to be affected by individual characteristics of responders. These results call for developing better regulations for identifying qualified surrogate decision-makers and reducing legal ambiguities.
Disciplines :
Neurosciences & behavior
Author, co-author :
Li, Meiqi ; International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China ; Intensive Care Unite, Hangzhou First People's Hospital, Hangzhou, China
Gosseries, Olivia ; Université de Liège - ULiège > GIGA > GIGA Neurosciences - Coma Science Group
Cheng, Lijuan; International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
Yan, Yifan ; School of Public Health, Zhejiang University, Hangzhou, China
Li, Yan; International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China ; School of Basic Medicine, Hangzhou Normal University, Hangzhou, China
Laureys, Steven ; Université de Liège - ULiège > Département des sciences cliniques ; Joint International Research Unit on Consciousness, CERVO Brain Research Centre, Laval University, Québec, Canada
Di, Haibo ; International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China ; School of Basic Medicine, Hangzhou Normal University, Hangzhou, China
Language :
English
Title :
Exploring end-of-life decision-making in China for disorders of consciousness.
NSCF - National Natural Science Foundation of China
Funding text :
This work was supported by the National Natural Science Foundation of China (81920108023), and the National Key Research and Development Program of China (Nos. 2022YFC3601200 and 2022YFE0141300). Interdisciplinary Research Project of Hangzhou Normal University (No. 2024JCXK07). BC is doctoral candidate at the GIGA Doctoral School for Health Science (University of Liege) and FNRS-ASP.; OG is a research associate and SL is research director at F.R.S.-FNRS. We thank the participants for their support and the university group members for their help in distributing the questionnaires.
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