MEDICAL TECHNOLOGY AT THE END OF LIFE - WHAT WOULD PHYSICIANS AND NURSES WANT FOR THEMSELVES

Background: Advance directives assume that patients are able to decide what interventions they would wish in the event of catastrophic illne ss. This study examines the preferences of nurses and physicians, who have extensive exposure to sick patients, for care at the end of life. Methods: Nursing and medical staff of a community teaching hospital w ere asked to complete the medical directive, detailing which of 12 int erventions they would wish for themselves in each of four scenarios. T wo additional scenarios were added to ascertain preferences for care i n the event of severe illness in a previously healthy 85-year-old subj ect and in a chronically ill 75-year-old subject. Results: Refusal rat e among the 127 nurses and 115 physicians who completed the questionna ire, averaged over the four scenarios, was 78%. Nurses and physicians refused 31% of proposed therapies in the case of acute illness in a pr eviously healthy 85-year-old subject and 57% of interventions in the c ase of major illness in a 75-year-old subject with multiple debilitati ng chronic illnesses. Nurses reported significantly higher refusal rat es than physicians for the scenarios involving possible reversible com a, the healthy 85-year-old subject, and the chronically ill 75-year-ol d subject. Factors predicting refusal patterns were age and being a nu rse. Conclusion: We conclude that physicians and nurses, who have exte nsive exposure to hospitals and sick patients, are unlikely to wish ag gressive treatment if they become terminally ill, demented, or are in a persistent vegetative state. Many would also decline aggressive care on the basis of age alone, especially in the presence of functional i mpairment. These findings call into question the utility of detailed a dvance directives and suggest a need to focus on the goals of treatmen t for all elderly patients.