How Life Should End: What Physicians Think

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Doctors see a lot of death. And so it might be interesting to know how they deal with their own end times.

A new study of aging physicians finds most have firm thoughts about their choices for life-sustaining treatment that didn't change over a three-year period, regardless of their physical and mental health.

Dr. Marsha Wittink of the University of Pennsylvania School of Medicine, Philadelphia, and her colleagues surveyed more than 800 physicians with an average age of 69. The physicians answered questions about their health status and end-of-life preferences in 1999 and again in 2002.

They were asked to consider what treatments they would want in the event of brain death that left them unable to speak or recognize people. They reported how likely they were to desire each of 10 interventions, including cardiopulmonary resuscitation (CPR), major surgery, a feeding tube and dialysis.

The results showed physicians fell into one of three groups regarding life-sustaining treatments, including:

Physicians who would want most of the interventions, considered aggressive care (12 percent in 1999, and 14 percent in 2002).
Physicians who would want intravenous fluids and antibiotics as the primary interventions, considered intermediate care (26 percent in 1999, and 26 percent in 2002).
Physicians who would decline most interventions, considered the least aggressive care (62 percent in 1999, and 60 percent in 2002).

While age and declines in health didn't impact a study participant's end-of-life choices, individuals without advance directives such as a living will or durable power of attorney were most likely to change their wishes over time.

"Efforts to improve the experience of patients and families at the end of life must incorporate patient perspectives," the researchers write. "Advance directives are one strategy through which patient preferences can be elicited and recorded, to be invoked at a time when the patient may not be able to make decisions directing care."

However, the researchers note, preferences for life-sustaining treatment given in one state of health may not reflect the choices patients would make if their health status changed.

The results are published in the Oct. 27 issue of the journal Archives of Internal Medicine.

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