The influence of physician race, age, and gender on physician attitudes toward advance care directives and preferences for end-of-life decision-making

OBJECTIVE: To determine whether physicians' preferences for end-of-life dec ision-making differ between blacks and whites in the same pattern as patien t preferences, with blacks being more likely than whites to prefer life-pro longing treatments. DESIGN: A mailed survey. SETTING AND PARTICIPANTS: American Medical Association (AMA) and National M edical Association (NMA) databases. To enrich the sample of black physician s, we targeted physicians in the AMA database practicing in high minority a rea zip codes and graduates of the traditionally black medical schools. MAIN OUTCOME MEASURES: Self-reported physician attitudes toward end-of-life decision-making and preference of treatment for themselves in persistent v egetative state or organic brain disease compared by race, controlling for age and gender. RESULTS: The 502 physicians (28%) who returned the questionnaire included 2 80 white and 157 black physicians. With regard to attitudes toward patient care, 58% of white physicians agreed that tube-feeding in terminally ill pa tients is "heroic," but only 28 % of black physicians agreed with the state ment (P < .001). White physicians were more likely than black physicians to find physician-assisted suicide an acceptable treatment alternative (36.6% vs 26.5% of black physicians) (P < .05). With regard to the physicians preferences for future treatment of themselve s for the persistent vegetative state scenario, black physicians were more than six times more likely than white physicians to request aggressive trea tments (cardiopulmonary resuscitation, mechanical ventilation, or artificia l feeding) for themselves (15.4% vs 2.5%) (P < .001). White physicians were almost three times as likely to want physician-assisted suicide (29.3% vs 11.8%) (P < .001) in this scenario. For a state of brain damage with no ter minal illness, the majority of all physicians did not want aggressive treat ment, but black physicians were nearly five times more likely than white ph ysicians (23.0% vs 5.0%) (P < .001) to request these treatments. White phys icians, on the other hand, were more than twice as likely to request physic ian-assisted suicide (22.5% vs 9.9%), P < .001 in this scenario. CONCLUSIONS: Physicians preferences for end-of-life treatment follow the sa me pattern by race as patient preferences, making it unlikely that low soci oeconomic status or lack of familiarity with treatments account for the dif ference. Self-denoted race may be a surrogate marker for other, as yet unde fined, factors. The full spectrum of treatment preferences should be consid ered in development of guidelines for end-of-life treatment in our diverse society.