Physicians' decisions to withhold and withdraw life-sustaining treatment.
BACKGROUND
Few data are available about physicians' decisions in regard to withholding or withdrawing life-sustaining measures. We therefore studied internists' views on this subject.


METHODS
We surveyed 1000 generalist and subspecialist internists about their views on withholding or withdrawing life-sustaining treatment. Thirty-two hypothetical cases were included. The effect of the demographic data on withholding or withdrawing treatment was analyzed via analysis of covariance and multiple logistic regression.


RESULTS
Of 1000 internists, 407 (41%) completed and returned surveys. A majority of respondents (51%) were willing to withhold or withdraw treatment in all 32 scenarios; 49% were unwilling to withhold or withdraw in at least 1 scenario. Respondents were likely to withhold treatment in 14 of 16 scenarios compared with 13.7 of 16 scenarios for withdrawing treatments (P<.001). Respondents withheld or withdrew feeding tubes in 6.6 of 8 scenarios (P<.001) and antibiotics in 6.7 of 8 scenarios (P = .001) compared with ventilators (7.1 of 8 scenarios) and dialysis (7.3 of 8 scenarios). Respondents were less likely to withhold or withdraw treatments in nonterminally ill (12.9 of 16 scenarios) (P = .02) and alert patients (13.2 of 16 scenarios) (P<.001) compared with terminally ill patients (14.9 of 16 scenarios) and patients with dementia (14.5 of 16 scenarios).


CONCLUSIONS
A large percentage of internists would be unwilling to adhere to some of patients' wishes to withhold or withdraw life-sustaining treatment. The clinical scenario and type of treatment affect internists' decisions about whether they would withhold or withdraw such treatment.
Department of Medicine, Christiana Care Health System, Wilmington, Delaware 19899, USA. nfarber@christianacare.org
Neil J
NJ
Farber
Pamela
P
Simpson
Tabassum
T
Salam
Virginia U
VU
Collier
Joan
J
Weiner
E Gil
EG
Boyer
D016223:Advance Directives; D001291:Attitude of Health Personnel; D016638:Critical Illness / Q000628:therapy*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D011795:Surveys and Questionnaires; D013727:Terminal Care; D028761:Withholding Treatment / Q000706:statistics & numerical data* / Q000639:trends