Specific sellckchem diagnostic categories (cardiovascular disease and trauma) were correlated with fewer limitation decisions. Furthermore, surgical patients were fully supported more often than were medical patients. On the contrary, patients admitted with a neurologic diagnosis were more likely to undergo limitation of treatment. These findings have two possible explanations. First, cardiovascular disease is deemed more reversible than is neurologic injury, which is viewed as a devastating irremediable damage. Second, in trauma as well as in many surgical patients, illness is sudden and unexpected, which may delay the recognition of futility and impede decision making.We observed that death does not always ensue shortly after withholding or withdrawal of therapy; time from withholding of therapy to death may be as long as 1 month.

This observation suggests the need for transfering patients whose death is not immediately imminent after limitation of treatment, to a suitable hospice, to administer appropriate palliative care.Our data indicate that paternalism prevails in the Greek ICUs studied. The physician possesses a dominant role in the decision-making process and retains the final responsibility for end-of-life practice. Relatives’ involvement in decision making is uncommon, and advance directives are rare. Respect for and confidence in medical authority are deep-rooted in Greek culture. Patients and families traditionally tend to entrust therapeutic decisions to physicians. In the same manner, end-of-life decisions are envisaged as purely clinical or professional judgments and are left to the doctor.

Besides, most patients with chronic terminal illnesses do not have full knowledge of their diagnosis or prognosis. Nondisclosure is believed to protect patients from anxiety and depression, and to keep hope alive. Last, as has emerged from several studies, in southern European countries, the ethical principle of beneficence still overshadows autonomy [6,18,28-30].The percentages of medical-record documentation of limitation decisions were low, a finding Batimastat that confirms the results of the Ethicus study, which revealed a south-to-north difference regarding the presence of written accounts of such decisions [31]. Ideally, each patient’s chart should have a complete documentation of the end-of-life practice. However, physicians may not believe this is necessary.