Table 2.

Factors considered in decisions about medical indication.

Thematic category	Factors considereda
Treatment-related and prognostic factors	Treatment goal, available treatment options Treatment invasiveness and treatment-related impairment, risk of complications and non-survival, necessary follow-up treatments, lacking prospect of better treatments in the future Reversibility of damages, chance for symptom improvement Expected disease course, life expectancy Expected level of motor and cognitive functioning, expected communication abilities and capacity to consent Anticipated quality of life: autonomy, participation in life, psychological suffering
Patient-related factors	Patient age, decision-making capacity Underlying disease and causes of symptoms, comorbidities Stability of current health status, symptom severity, cognitive situation Previous symptoms and suffering, previous treatments and treatment outcomes Patient’s (presumed) wishes, patient’s (presumed) subjective experience of the disease and psychological distress, treatment compliance
Family-related factors	Family context: siblings, cultural background Family/parent wishes and attitudes Burden on the family and coping resources
Physician-related factors	Difficulties withholding and withdrawing life-sustaining treatment, fear of over-treatment Optimism, hope for medical progress or a miracle Personal involvement in patient’s care, own emotional response, “gut feeling” Professional specialization, own experience with similar patients, usual practice
Ethical and legal factors	Right for life, protection of life Child’s best interests, harm avoidance Distributive justice, respect to organ donor Legislation allowing for treatment limitations
Economic factors	Financial costs for society associated with provision of treatment/care resources

^aListed order of reasons does not reflect priority.