Do Physicians' Own Preferences for Life-Sustaining Treatment Influence Their Perceptions of Patients' Preferences? a Second Look
Schneiderman, Lawrence J.
Kaplan, Robert M.
Cambridge Quarterly of Healthcare Ethics. 1997 Spring; 6(2): 131-137.
Previous studies have documented the fallibility of attempts by surrogates and physicians to act in a substituted judgment capacity and predict end-of-life treatment decisions on behalf of patients. We previously reported that physicians misperceive their patients' preferences and substitute their own preferences for those of their patients with respect to four treatments: cardiopulmonary resuscitation (CPR) in the event of cardiac arrest, ventilator for an indefinite period of time, medical nutrition and hydration for an indefinite period of time, and hospitalization in the event of pneumonia. This paper extends our previous observations and reports on a different and larger population of subjects, employing a more detailed procedure-oriented advance directive instrument as well as a quality-of-life questionnaire. Our hypothesis remains the same, namely, that physicians' predictions of their patients' end-of-life treatment choices are closer to the choices they would make for themselves than to the choices expressed by their patients. Since physicians are the ones who ultimately exercise control over these important decisions, any unrecognized projection of personal preferences onto their patients would raise serious concerns about physicians acting in a substituted judgment capacity. It would also emphasize the importance of patients choosing surrogate decisionmakers carefully and, even more important, explicating clearly their directive instructions as part of advance care planning.
Advance Care Planning; Advance Directives; Aids; Allowing to Die; Attitudes; Brain; Brain Pathology; Cancer; Comparative Studies; Consensus; Coma; Consent; Decision Making; Evaluation; Evaluation Studies; Informed Consent; Life; Nutrition; Pain; Patients; Physicians; Prognosis; Prolongation of Life; Quality of Life; Resuscitation; Survey; Substituted Judgment; Terminally Ill; Third Party Consent; Treatment Refusal; Values; Withholding Treatment;
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Do Physician's Own Preferences for Life-Sustaining Treatment Influence Their Perceptions of Patients' Preferences? A Second Look Schneiderman, Lawrence J.; Kaplan, Robert M.; Rosenberg, Esther; Teetzel, Holly (1997-03)
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