End-of-Life Advice Not Always Welcome

Aug. 26 -- TUESDAY, Aug. 25 (HealthDay News) -- When deciding whether to turn off life support for a loved one, family members aren't always interested in their doctor's advice, new research shows.

The finding runs counter to assumptions among critical-care providers that families making such a heart-wrenching choice would welcome a physician's impartial opinion.

Critically ill patients who don't have advance directives often require others to make medical decisions for them, said study author Douglas B. White, of the University of Pittsburgh Medical Center.

Family members often make the decision based on what they believe the patient would have wanted.

"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," White said. "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."

Researchers showed videos to 169 surrogates recruited from intensive care units at University of California San Francisco Medical Center. The videos depicted a dramatized "family conference" in which surrogates must decide whether to withdraw life support from a loved one who has a small chance of survival with continued treatment, but a high likelihood of being functionally impaired and needing a ventilator.

In one video, the doctor tells the surrogate to make the choice that's consistent with the patient's values, and that only the surrogate knows what that is. In the second video, the doctor tells the surrogate that the patient probably wouldn't want continued attempts to keep him or her alive.

About 56 percent of surrogates said they preferred the video in which the physician offered an opinion to limit life support, while 42 percent preferred the video in which no recommendation was offered. Two percent had no preference.