Treatment goal limitations in acute hospital care : A retrospective empirical ethics study of documentation and recorded reasoning.

Authors

Thomas Fuchs, Thomas Gremsl

Published in

Wiener klinische Wochenschrift. Jul 29, 2026. Epub Jul 29, 2026.

Abstract

Treatment goal limitations, such as "do not resuscitate", "do not escalate" and "comfort terminal care" are frequent in acute hospital care for patients with advanced illness, multimorbidity or impending death. Their ethical defensibility depends on transparent documentation of medical indications, proportionality and, where relevant, patient will.
To examine whether documentation made medical rationale, patient will, advance directives, relatives' involvement or ethics consultation visible.
We retrospectively analyzed documentation in an Austrian internal medicine department with intensive care over 12 months. Documents were identified in the hospital information system and descriptively analyzed. Deceased patients with documented limitations underwent manual review. Data were anonymized and analyzed using Microsoft Excel for Microsoft 365 (Microsoft Corporation, Redmond, WA, USA) and IBM SPSS Statistics, version 29 (IBM Corp., Armonk, NY, USA).
Across 3998 inpatient stays involving 1829 patients, 277 patients had a documented treatment goal limitation (15.1%). Among 174 deceased patients, 111 had a documented limitation at death (63.8%). The most frequent order was combined do not resuscitate/do not escalate (75/111; 67.6%), followed by isolated do not resuscitate (23/111; 20.7%). Complete records were available for 101 cases; in 10 the rationale was not clearly traceable. Among the 101 manually reviewed cases, an explicit or presumed patient will was documented in 7 cases (6.9%), involvement of relatives in 13 cases (12.9%) and ethics consultation in 1 case (1.0%); medical rationale or physician decision was documented in 90 of 91 cases with traceable rationale (98.9%).
Treatment goal limitations were common and usually medically justified in the records. The findings do not imply inappropriate decisions or lack of communication but show limited reconstruction of patient-centered reasoning. Documentation should make clearer how benefit, care, respect for autonomy and justice informed treatment limitation.

PMID:
42525299
Bibliographic data and abstract were imported from PubMed on 29 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.