At the end of a critically ill patient's life, a doctor's recommendation about whether to withdraw life support -- based, one would assume, on expertise and facts -- can get in the way of what really matters: values. That seems to be the opinion of a significant number of people charged with making life-support decisions for others.
Researchers at UC San Francisco asked 169 decision-making surrogates to watch two videos depicting life-support discussions between a physician and a daughter in charge of her father's care. The results, published in the Aug. 15 issue of American Journal of Respiratory and Critical Care Medicine, came as something of a surprise to doctors who have been pushed in recent years to offer more guidance to family members.
In one video, the doctor offered no recommendation to the presumably at-sea relative. Here's a bit of the physician's dialogue: "You’re right; it is a tough decision for you. Again, remember though, that the most important thing is for you to make the choice that your father would have made if he could speak for himself. Or make the choice that’s most consistent with his values. We rely on you to make this decision, and it should be right for him."
In the other video, the doctor made a recommendation to end life support. Here's some of that dialogue: "Based on what you’ve said about your father as a person, I really think that he wouldn’t want to continue with treatment if it meant ending up in a nursing home. I know this is hard to hear, but I would recommend that we focus on keeping him comfortable and recognize that trying to get him well enough to go to a nursing home is not what he would have wanted."
After watching those videos, 56% of the surrogates said they would want a doctor's recommendation about life support; 42% said they would not. For 2%, it didn't matter.
Poor doctors. Here they've been thinking that people across the board would actually want their educated two-cents' worth about whether to withdraw life support.
To be sure, some did. (So, docs, no need to leave everyone floundering about on their own.) But the researchers' very logical conclusions, as stated in the abstract: "These findings suggest that physicians should ask surrogates whether they wish to receive a recommendation regarding life support decisions and should be flexible in their approach to decision-making." Here's the full article, should you want to parse the data yourself.
Perhaps what this study drives home is the need for surrogates to discuss the values of the person they're charged with representing with the person himself (or herself) -- while such discussions are still possible.
-- Tami Dennis
Photo: Wonder what the doctors think? First, ask yourself: Do you really want to know?
Credit: Associated Press