The following is a summary of “End-of-life decision disparities according to the gross national income in critically ill patients: a secondary analysis of the ETHICUS-2 study,” published in the March 2025 issue of Annals of Intensive Care by Martin-Loeches et al. 

Researchers conducted a retrospective study to examine the association between end-of-life decisions and time to death in a global cohort of individuals with critical illness from the Ethicus-2 study on intensive care unit (ICU) practices. 

They performed a post hoc analysis using data from a global observational study that included adult ICU individuals who died between September 1, 2015, and September 30, 2016, and data were collected from 199 ICUs across 36 countries. 

The results showed that end-of-life pathways were analyzed for 10,547 non-survivors of ICU. In high-income countries, time to death was significantly shorter than in middle-income countries. Therapeutic decisions influenced ICU length of stay (LOS) across gross national income (GNI) groups. Individuals in high-income countries without a decision had the shortest LOS, while withholding or withdrawing life-sustaining treatment resulted in longer LOS in both middle- and high-GNI countries. 

Investigators concluded that global end-of-life decision-making lacked uniformity, with outcomes influenced by GNI and high-income nations exhibiting shorter ICU stays prior to death. 

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-025-01419-1