title: Residents' perceptions about surrogate decision makers' financial conflicts of interest in ventilator withdrawal.
abstract: OBJECTIVE
  There have been no studies to date that examine physicians' decisions to withdraw life-sustaining treatment for patients based on their surrogates' financial gain. The authors' objective was to ascertain physician attitudes about withdrawing life-sustaining treatment when financial considerations are involved.
  
  
  METHODS
  A survey was developed and pretested containing eight scenarios in which a terminally ill patient's spouse had a decision to make regarding withdrawal of the ventilator, which was deemed medically futile. Nested variables included agreement or disagreement between the spouse and patient, decision to withdraw or continue the ventilator, and financial gain or no financial gain for the spouse. The authors surveyed all internal medicine residents at the University of California, San Diego in the autumn of 2011 and winter of 2012. The responses on each of the three variables for which respondents were likely to withdraw the ventilator were analyzed via student's t-tests.
  
  
  RESULTS
  Residents were more likely to withdraw the ventilator when requested to do so than when it was requested to be continued. They were also more likely to withdraw the ventilator when there was agreement in the decision between the spouse and the patient. Residents were more likely to withdraw the ventilator when the spouse would not benefit financially.
  
  
  CONCLUSIONS
  Internal medicine residents make some decisions about whether to withdraw life-sustaining treatment based on financial considerations. There needs to be ongoing communication with residents about end-of-life decisions where conflicts may exist between the surrogate decision makers and patients or physicians.
authors.affiliation: San Diego School of Medicine, University of California , San Diego, La Jolla, California.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Wastila
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Farber
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002140:California; D003657:Decision Making / Q000941:ethics*; D004467:Economics; D005066:Euthanasia, Passive / Q000941:ethics*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000941:ethics / Q000592:standards / Q000706:statistics & numerical data; D007396:Internship and Residency / Q000941:ethics* / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D018447:Medical Futility / Q000941:ethics*; D009369:Neoplasms; D019727:Proxy; D011795:Surveys and Questionnaires; D019452:Terminally Ill; D012122:Ventilators, Mechanical