Table 1—

Definitions of end-of-life decisions proposed in the questionnaire

DecisionDefinition
EuthanasiaA doctor intentionally killing a person who is suffering unbearably and hopelessly at the latter’s voluntary, explicit, repeated, well-considered and informed request
WithholdingA planned decision not to institute therapies that would otherwise be warranted (i.e. intubation, renal replacement therapy, increased vasopressor infusion doses, surgery, transfusion, nutrition and hydration)
WithdrawalDiscontinuation of treatments that have been started (i.e. decreasing FI,O2 to 21%, extubation, switching the ventilator off, suspension of vasopressor infusions, etc.)
NIMV as ceiling of ventilatory careElective decision that the patient will not undergo intubation, with NIMV as the ceiling treatment
Principle of double effectThe use of opiates, sedation or similar with the intention of palliating symptoms of dyspnoea, pain or distress, which is likely to simultaneously shorten life
DNR and DNI ordersAggressive management up to, but not including, attempts at cardiopulmonary resuscitation (DNR) and intubation (DNI)
End-stage respiratory patientA patient with respiratory failure, with either COPD, an FEV1 of <0.75 L and at least one admission for hypercapnic respiratory failure or a restrictive defect with an FVC of <0.6 L and/or at least one admission for hypercapnic respiratory failure. An additional criterion is the need for assistance with at least one instrumental activity of daily living (e.g. housework or shopping), in order to improve the prognostication with respect to life expectancy
  • NIMV: noninvasive mechanical ventilation; DNR: do not resuscitate; DNI: do not intubate; FI,O2: inspiratory oxygen fraction; COPD: chronic obstructive pulmonary disease; FEV1: forced expiratory volume in one second; FVC: forced vital capacity.