Physicians' own preferences to the limitation and withdrawal of life-sustaining therapy

While limiting and forgoing therapy at the end of life is now accepted on m edical, ethical, moral and legal grounds, many Americans continue to die wi th heroic measures being taken to prevent their death. Recent studies have demonstrated that physicians frequently attend to their patients without kn owledge of their preferences with regards to end-of-life issues. It is post ulated that a physician's personal preferences with regard to the limitatio n and withdrawal of life support and active euthanasia would effect the dis cussion they had with their patients. The purpose of this study was to anal yze end-of-life preferences of a diverse group of practicing physicians. Th e participants were active attending physicians at a community hospital, a rural referral center, a large tertiary care referral academic complex, and a specialized tertiary care referral center all within the United States. A questionnaire was developed which was mailed to attending physicians at t he four participating medical centers. The respondents provided basic demog raphic data, do-not-resuscitate (DNR) preferences under various clinical ci rcumstances as well as responses to a number of case vignettes. Six hundred and forty physicians responded to the survey. The mean age of the responde nts was 46 years; 72% were male. In the event of a cardiac arrest less than 20% of respondents would want to undergo cardiopulmonary resuscitation in the setting of chronic end stage organ failure; the positive response rate was 5% for metastatic cancer and 2% for Alzheimer's disease. If death was i mminent, 87% of physicians indicated they would want treatment withdrawn. S imilarly, 95% of respondents indicated that they would want treatment withd rawn should they be in a persistent vegetative state. Only 1% of respondent s believed that health care providers should never remove or withhold life- sustaining therapy. Should they have advanced motor neuron disease, 38% of physicians indicated they would request that their life be ended. The major ity of physicians surveyed volunteered that they would want life-sustaining measures to be limited at the end of their life. A significant number were in favor of active euthanasia. This study suggests that it is unlikely tha t physicians' personal beliefs in regards to end-of-life care result in the failure to discuss these issues with their patients. (C) 1999 Elsevier Sci ence Ireland Ltd. All rights reserved.