Abstract
OBJECTIVE. This study was undertaken to identify attributes of physicians associated with physicians' decisions to withdraw life support. METHODS. Of the 862 Pennsylvania internists surveyed and asked to make decisions in response to hypothetical vignettes and to report their actual experience with the withdrawal of life support, 485 (56%) responded. The data were analyzed with regression models. RESULTS. With other factors controlled, physicians were more willing to withdraw life support if they were young, practiced in a tertiary care setting, or spent more time in clinical practice; they were less willing if they were Catholic or Jewish. Physicians reported a higher frequency of actually withdrawing life support if they were young, had more contact with ICU patients, spent more time in clinical practice, or were specialists. Physicians with a greater willingness to withdraw were more likely to report having done so. CONCLUSIONS. Physicians' personal characteristics are associated with both their preferences and their practice in the withdrawal of life support, and a greater willingness to withdraw is associated with a higher frequency of withdrawal. The influence of physician characteristics demonstrates that patient preferences and clinical circumstances do not exclusively govern such ethical decisions.
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Selected References
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- Caralis P. V., Hammond J. S. Attitudes of medical students, housestaff, and faculty physicians toward euthanasia and termination of life-sustaining treatment. Crit Care Med. 1992 May;20(5):683–690. doi: 10.1097/00003246-199205000-00023. [DOI] [PubMed] [Google Scholar]
- Christakis N. A., Asch D. A. Biases in how physicians choose to withdraw life support. Lancet. 1993 Sep 11;342(8872):642–646. doi: 10.1016/0140-6736(93)91759-f. [DOI] [PubMed] [Google Scholar]
- Danis M., Patrick D. L., Southerland L. I., Green M. L. Patients' and families' preferences for medical intensive care. JAMA. 1988 Aug 12;260(6):797–802. [PubMed] [Google Scholar]
- Davidson K. W., Hackler C., Caradine D. R., McCord R. S. Physicians' attitudes on advance directives. JAMA. 1989 Nov 3;262(17):2415–2419. [PubMed] [Google Scholar]
- Eisenberg J. M. Sociologic influences on decision-making by clinicians. Ann Intern Med. 1979 Jun;90(6):957–964. doi: 10.7326/0003-4819-90-6-957. [DOI] [PubMed] [Google Scholar]
- Evans A. L., Brody B. A. The do-not-resuscitate order in teaching hospitals. JAMA. 1985 Apr 19;253(15):2236–2239. [PubMed] [Google Scholar]
- Goetzler R. M., Moskowitz M. A. Changes in physician attitudes toward limiting care of critically ill patients. Arch Intern Med. 1991 Aug;151(8):1537–1540. [PubMed] [Google Scholar]
- Neu S., Kjellstrand C. M. Stopping long-term dialysis. An empirical study of withdrawal of life-supporting treatment. N Engl J Med. 1986 Jan 2;314(1):14–20. doi: 10.1056/NEJM198601023140103. [DOI] [PubMed] [Google Scholar]
- Nightingale S. D., Grant M. Risk preference and decision making in critical care situations. Chest. 1988 Apr;93(4):684–687. doi: 10.1378/chest.93.4.684. [DOI] [PubMed] [Google Scholar]
- Novack D. H., Detering B. J., Arnold R., Forrow L., Ladinsky M., Pezzullo J. C. Physicians' attitudes toward using deception to resolve difficult ethical problems. JAMA. 1989 May 26;261(20):2980–2985. [PubMed] [Google Scholar]
- Pearlman R. A., Inui T. S., Carter W. B. Variability in physician bioethical decision-making. A case study of euthanasia. Ann Intern Med. 1982 Sep;97(3):420–425. doi: 10.7326/0003-4819-97-3-420. [DOI] [PubMed] [Google Scholar]
- Rostain A. Deciding to forgo life-sustaining treatment in the intensive care nursery: a sociologic account. Perspect Biol Med. 1986 Autumn;30(1):117–134. doi: 10.1353/pbm.1986.0097. [DOI] [PubMed] [Google Scholar]
- Schneiderman L. J., Jecker N. S., Jonsen A. R. Medical futility: its meaning and ethical implications. Ann Intern Med. 1990 Jun 15;112(12):949–954. doi: 10.7326/0003-4819-112-12-949. [DOI] [PubMed] [Google Scholar]
- Smedira N. G., Evans B. H., Grais L. S., Cohen N. H., Lo B., Cooke M., Schecter W. P., Fink C., Epstein-Jaffe E., May C. Withholding and withdrawal of life support from the critically ill. N Engl J Med. 1990 Feb 1;322(5):309–315. doi: 10.1056/NEJM199002013220506. [DOI] [PubMed] [Google Scholar]
- Uhlmann R. F., Pearlman R. A. Perceived quality of life and preferences for life-sustaining treatment in older adults. Arch Intern Med. 1991 Mar;151(3):495–497. [PubMed] [Google Scholar]
- Von Preyss-Friedman S. M., Uhlmann R. F., Cain K. C. Physicians' attitudes toward tube feeding chronically ill nursing home patients. J Gen Intern Med. 1992 Jan-Feb;7(1):46–51. doi: 10.1007/BF02599102. [DOI] [PubMed] [Google Scholar]
- Winkenwerder W., Jr Ethical dilemmas for house staff physicians. The care of critically ill and dying patients. JAMA. 1985 Dec 27;254(24):3454–3457. [PubMed] [Google Scholar]
- Wu A. W., Folkman S., McPhee S. J., Lo B. Do house officers learn from their mistakes? JAMA. 1991 Apr 24;265(16):2089–2094. [PubMed] [Google Scholar]
