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End-Of-Life Decisions: MD Opinions Are Not Always Wanted

August 11, 2009
At the end of life, critically ill patients frequently require surrogates to make their medical decisions for them. In the absence of advance directives from the patient, caregivers must rely on what they believe would have been the patients’ desires. "This puts an enormous emotional burden on surrogates—not only are they losing a loved one, they also may feel burdened by guilt about allowing the patient to die," explains Dr. Douglas B. White, of the University of Pittsburgh Medical Center. "It was therefore assumed by some in the medical community that a doctor’s dispassionate advice could reduce some of that burden and help surrogates make a good decision with less second-guessing themselves. However, there was little or no research to support this assumption." Dr. White is the lead author of new research that challenges these long-held beliefs in the critical care community. The research, to be published in the August 15 issue of the American Journal of Respiratory and Critical Care Medicine, found that surrogates are virtually split when it comes to how much guidance they want to receive from physicians in making end-of-life medical choices on behalf of critically ill patients. In fact, some caregivers of critical care patients prefer doctors to keep their opinions on life support decisions to themselves. "In fact, what we found was that, while a slight majority did prefer doctors to help them make those difficult decisions, many felt that it was a decision they wanted to make without guiding input from doctors other than an explanation of the options," says Dr. White. "A very important part of American bioethics is respecting patient’s choices. The family’s most important job when acting as a surrogate decision maker is to give voice to the patient’s values. I think our research highlights that the physician’s job is to be flexible enough and insightful enough to respond to the surrogate’s individual needs for guidance.”