Do Physicians’ Own Preferences for Life-Sustaining Treatment Influence Their Perceptions of Patients’ Preferences?

Patient autonomy, especially the right to choose among alternative effective therapies, is now well established as a guiding principle in medical-treatment decisions. In many critical-care situations, however, patients are no longer capable of participating in the decision-making process. Despite the increasing interest in advance directives, such as living wills or durable powers of attorney for health care, only a small percentage of patients have executed such documents. And even those patients who have signed vaguely worded living wills or designated proxies may still leave surrogate decision makers with no clear information about treatment preferences. Therefore, on many occasions when important life-sustaining treatment decisions have to be made, family members--in conjunction with physicians--are obliged to act without the specific knowledge of what patients would want for themselves. Unfortunately, there is evidence that substitute decision makers, even those who have had a long, intimate familiarity with a patient, may not be accurate predictors of patients’ preferences. 1 Since physicians are powerful agents in the medical decision-making process and are the ones who ultimately control the treatments and procedures, we