Medical specialists prefer to withdraw familiar technologies when discontinuing life support.
OBJECTIVE
To assess how members of different specialties vary in their decisions about which form of life support to withdraw. The hypothesis was that each specialty would be more comfortable withdrawing its "own" form of life support relative to other forms and other specialties.


METHODS
Mail survey.


METHODS
24 medical centers.


METHODS
225 specialists in six specialties and 225 comparison physicians randomly matched according to percentage of time devoted to clinical practice.


METHODS
The six specialties were linked with six life-sustaining technologies related to their special expertise: 1) pulmonologists with mechanical ventilation, 2) nephrologists with hemodialysis, 3) gastroenterologists with tube feedings, 4) hematologists with blood products, 5) cardiologists with intravenous vasopressors, and 6) infectious disease specialists with antibiotics. The subjects ranked different forms of life support in the order in which they would prefer to withdraw them. They also expressed their preferences in response to hypothetical clinical vignettes.


RESULTS
In five of the six specialties, the 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 form of life support closely linked with their own specialty.


CONCLUSIONS
Just as some specialist physicians tend to reach for different technologies first in treating patients, they also tend to reach for different technologies first when ceasing treatment. Specialists' preferences for different ways to withdraw life support not only may reflect a special understanding of the limits of certain technologies, but also may reveal how ingrained are physicians' patterns of practice.
Section of General Internal Medicine, University of Chicago, IL, USA.
N A
NA
Christakis
D A
DA
Asch
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016913:Blood Component Transfusion; D003625:Data Collection; D004750:Enteral Nutrition; D005066:Euthanasia, Passive / Q000706:statistics & numerical data*; D006801:Humans; D008020:Life Support Care / Q000706:statistics & numerical data*; D008511:Medicine / Q000706:statistics & numerical data*; D010414:Pennsylvania; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D006435:Renal Dialysis; D012121:Respiration, Artificial; D013038:Specialization; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D028761:Withholding Treatment
D000900:Anti-Bacterial Agents; D014662:Vasoconstrictor Agents