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Table 2 The identified statements

From: Withdrawing or withholding treatments in health care rationing: an interview study on ethical views and implications

Themes # Statement Context
Patients’ need for treatment 1 An ill medical condition can make a physician’s decision to withdraw or withhold a treatment easier PHY/POR
  2 An ill medical condition can make the physician more willing to take higher risks and not withhold treatments PHY
  3 It might be easier for both the physician and the patient when withdrawing or withholding a treatment from a patient if alternative treatments exist PHY/POR
  4 The patient’s quality of life is important when deciding to withdraw or withhold treatment PHY/POR
Treatment effect in relation to alternative treatments 5 The healthcare sector provides inefficient treatments to patients PHY/POR
  6 Treatments are commonly withdrawn too late from patients in practice PHY/POR
  7 Physicians sometimes withhold treatments from patients due to cost-effectiveness PHY/POR
  8 Physicians sometimes withdraw treatments from patients due to cost-effectiveness PHY/POR
  9 Physicians commonly withdraw treatments from patients because they are ineffective or cause harm, rather than for cost-effectiveness reasons PHY/POR
  10 A treatment that has been proven to be ineffective for a specific patient should be withdrawn PHY/POR
  11 It must be acceptable for physicians to withdraw ineffective treatments PHY/POR
  12 A treatment that has proven to be effective for a specific patient should not be withdrawn by the healthcare service, even if it is not reimbursed PHY/POR
  13 A treatment that has proven to be effective for a patient participating in a clinical study should not be withdrawn PHY/POR
  14 Patients can understand if a treatment is withdrawn after a clinical study POR
  15 The expected net patient benefit of a treatment can affect the physician’s decision to withdraw or withhold a treatment PHY
  16 It can be helpful for a physician to evaluate a treatment’s effects when deciding to withdraw a treatment PHY/POR
  17 It can be difficult for a physician to evaluate all effects a treatment has or will have for a patient PHY/POR
  18 The use of one treatment can exclude the use of alternative treatments POR
Patient–professional communication 19 Involving patients in decision-making can facilitate withdrawals PHY/POR
  20 Agreements between a physician and a patient can facilitate treatment withdrawals PHY/POR
  21 Agreements between a physician and a patient can be the difference between withdrawing and withholding treatments POR
  22 It can be easier to withdraw a treatment if the physician informs the patient of the conditions for the treatment before starting it PHY/POR
  23 It is easier for the physician to withdraw treatments if the patient understands the information given to them PHY/POR
Patient–professional relationship 24 The physician should represent the patient when deciding to withdraw or withhold treatments PHY/POR
  25 Having a relationship between the physician and the patient can facilitate treatment withdrawal PHY/POR
  26 Spending extra time to support a patient psychologically makes it easier for the patient if their treatment is withdrawn POR
  27 It can be comforting for relatives if the physician decides whether a treatment is withdrawn or withheld PHY
  28 Having too close a relationship between the physician and the patient can make the physician act unprofessionally when withdrawing a treatment PHY
  29 The physical meeting with patients makes it more difficult for physicians to decide to withdraw or withhold treatments for specific patients than for patient groups PHY/POR
Healthcare responsibility 30 It is a physician’s obligation to withdraw ineffective or harmful treatments PHY/POR
  31 A physician has more obligations when prescribing unofficial treatments to patients PHY/POR
  32 Patients might lose confidence in the healthcare system if effective treatments are withdrawn because of reimbursement status PHY
  33 Expensive treatments should be publicly funded POR
  34 The pharmaceutical company should finance effective treatments for patients after a study is completed until an official recommendation is given PHY/POR
Ethical values 35 It is psychologically easier to withhold a treatment due to cost-effectiveness than to withdraw it PHY/POR
  36 There is an ethical difference between withdrawing and withholding treatments due to a lack of cost-effectiveness PHY/POR
  37 It is more important for physicians to make an individual assessment for patients with previous access to treatments that lack cost-effectiveness than to withdraw treatments to uphold patient equality PHY/POR
  38 Patients might not experience the same human value if their treatments are withdrawn due to a lack of cost-effectiveness POR
  39 Withdrawing and withholding treatments differently might lead to patients seeking healthcare from other healthcare providers PHY/POR
  40 It is unjust when different healthcare providers withdraw and withhold treatments unequally PHY/POR
Professional support 41 Physicians feel alone when deciding to withdraw or withhold treatments PHY
  42 It can be helpful for a physician to consult other physicians when deciding to withdraw or withhold treatments PHY
  43 Guidelines from a national level on treating new patients and patients with previous access to treatments after new recommendations can facilitate treatment withdrawals for physicians and patients PHY/POR
  44 Guidelines from a national level should be accessible for physicians PHY
  45 Guidelines from a national level may not be applicable in all healthcare scenarios POR
  46 It could be helpful for a physician to have reflected on ethical problems related to priorities when making priority decisions PHY/POR
Reimbursement system 47 Physicians and patient organization representatives are supportive of healthcare making priority decisions PHY/POR
  48 Physicians tend to prioritize their own patient groups PHY
  49 Patient organizations represent their own patient groups POR
  50 The treatment assessment process is not sufficiently transparent for patients POR
  51 Patients are not sufficiently involved in the treatment assessment process POR
  52 Patients want access to new treatments POR
  53 It takes a long time for authorities to implement new treatments PHY/POR
  54 A patient cannot demand access to the experimental treatment in a clinical study PHY/POR
  55 There is a difference between what is medically best and what is practically possible when prioritizing treatments between patients PHY/POR
  1. PHY, physician; POR, patient organization representative