MEDICAL SPECIALISTS PREFER TO WITHDRAW FAMILIAR TECHNOLOGIES WHEN DISCONTINUING LIFE-SUPPORT

OBJECTIVE: To assess how members of different specialties vary in thei r decisions about which form of life support to withdraw, The hypothes is was that each specialty would be more comfortable withdrawing its ' 'own'' form of life support relative to other forms and other specialt ies, DESIGN: Mail survey. SETTING: 24 medical centers, PARTICIPANTS: 2 25 specialists in six specialties and 225 comparison physicians random ly matched according to percentage of time devoted to clinical practic e, MEASUREMENTS: The six specialties were linked with six life-sustain ing technologies related to their special expertise: 1) pulmonologists with mechanical ventilation, 2) nephrologists with hemodialysis, 3) g astroenterologists with tube feedings, 4) hematologists with blood pro ducts, 5) cardiologists with intravenous vasopressors, and 6) infectio us disease specialists with antibiotics, The subjects ranked different forms of life support in the order in which they would prefer to with draw them. They also expressed their preferences in response to hypoth etical clinical vignettes, RESULTS: In five of the six specialties, th e specialists had a relative preference for withdrawing their ''own'' form of life support, compared with the preferences of the comparison physicians, Overall, the physicians tended to prefer withdrawing a for m of life support closely linked with their own specialty, CONCLUSIONS : Just as some specialist physicians tend to reach for different techn ologies first in treating patients, they also tend to reach for differ ent technologies first when ceasing treatment, Specialists' preference s for different ways to withdraw life support not only may reflect a s pecial understanding of the limits of certain technologies, but also m ay reveal how ingrained are physicians' patterns of practice.