A cross-cultural comparison of attitudes towards life support limitation in Sweden and Canada

Objective: To compare the attitudes of intensive care unit (ICU) healthcare workers towards withholding and withdrawing life support in Sweden and Canada. Design: Nationwide surveys in two countries. Setting: ICUs in 49 university-affiliated and/or tertiary referral hospitals. Participants: Intensive care physicians and nurses. Interventions: None. Measurements and main results: The response rates were 1,361/1,795 (76%) for Canada and 846/1,081 (78%) for Sweden. Respondents chose between five levels of care, ranging from comfort measures to full intensive care, in two of 12 different clinical scenarios. Taking all other variables into account, Swedish healthcare workers chose more aggressive levels of care than did their Canadian colleagues, the difference in mean level of care being 0.38 on a five-point scale. Conclusions: Healthcare personnel in countries sharing a common cultural heritage and with similar healthcare funding differ in attitudes towards end-of-life issues.