title: The luck of the draw: physician-related variability in end-of-life decision-making in intensive care.
abstract: OBJECTIVE
  To critically analyze physician-related variability in end-of-life decision-making in intensive care.
  
  
  METHODS
  An ethical analysis of factors contributing to physician-related variability in end-of-life decision-making.
  
  
  RESULTS
  There is variability in decision-making about life support, both within and between intensive care units. Physician age, race, religion, attitude to risk, and personality factors have been associated with decisions to provide or limit life-sustaining treatment, though it is unclear how much these factors affect patient outcome. Inconsistency in decision-making appears worryingly arbitrary, and may mean that patients' values are sometimes being ignored or overridden. However, physician influence on decisions may also sometimes be appropriate and unavoidable, particularly where patient values are unclear.
  
  
  CONCLUSIONS
  We argue that, although physician-related variability in end-of-life care can never be eliminated entirely, it is potentially ethically problematic. We outline four potential strategies for reducing the "roster lottery."
authors: Discipline of Obstetrics and Gynecology, Women's and Children's Hospital, University of Adelaide, 72 King William Rd, North Adelaide, SA 5006, Australia. dominic.wilkinson@adelaide.edu.au
authors: Dominic J C
authors: DJ
authors: Wilkinson
authors: Robert D
authors: RD
authors: Truog
mesh_terms: D016223:Advance Directives; D001291:Attitude of Health Personnel; D003657:Decision Making / Q000941:ethics*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D057240:Patient Preference; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000941:ethics*; D013727:Terminal Care / Q000941:ethics*; D028761:Withholding Treatment / Q000941:ethics*