Doctors Don't Want Aggressive End-of-Life Treatment for Themselves

By Jane Farrell

Although most physicians would choose a do-not-resuscitate code for themselves when terminally ill, they tend to pursue life-prolonging treatment for patients in a similar condition, new research shows.
The study, conducted by researchers from the Stanford University School of Medicine, demonstrates a “disconnect” that needs to be further explored.

“Why do we physicians choose to pursue such aggressive treatment for our patients when we wouldn’t choose it for ourselves?” said lead author VJ Periyakoil, director of the Stanford Palliative Care Education and Training Program. “The reasons likely are multifaceted and complex.”

The investigators analyzed how attitudes have changed since the passage of the Self-Determination Act in 1990, a law designed to give patients more control over determining end-of-life care decisions.

The study involved two sets of groups of subjects: 790 physicians from Arkansas who participated in a advance directive “attitude survey” in 1989, and 1,081 physicians from Stanford Hospital & Clinics and the Veterans Affairs Palo Alto Health Care System who answered the same questions in 2013.

The results showed that doctors’ attitudes toward advance directives toward themselves and toward others have changed little between those years.

“The needle has not moved very much,” said Periyakoil, who is also associate director of palliative care services at the Palo Alto VA centervention. That might be because of what the study says is the medical profession’s focus on aggressive treatment at the end of life, although most people say now that they would rather die at home, without extraordinary interventions.

“A big disparity exists between what Americans say they want at the end of life and the care they actually receive,” the study said. “More than 80 percent of patients say that they wish to avoid hospitalizations and high-intensity care at the end of life, but their wishes are often overridden. Patients’ voices are often too feeble and drowned out by the speed and intensity of a fragmented health-care system.”

“Our current default is ‘doing,’ but in any serious illness there comes a tipping point where the high-intensity treatment becomes more of a burden than the disease itself,” said Periyakoil, who trains physicians in palliative medicine. “It’s tricky, but physicians don’t have to figure it out by themselves. They can talk to the patients and their families and to the other interdisciplinary team members, and it becomes much easier.”

The study was published in the journal PLOS One.