Variability in Physician Bioethical Decision-Making

Abstract

A patient management problem was developed to assess differences in case information processing and variability in physicians' decisions to withhold supportive therapy. An interview was done to assess physicians' values and elicit reasons for their decisions. Two hundred and five residents, attending physicians, and community practitioners in internal medicine and family medicine were interviewed. Internal medicine residents were most inclined to allow the patient to die, private practitioners to provide respirator support. Residents and attending physicians gave higher value to, and sought significantly more, socioeconomic information about the patient than did private practitioners, and also estimated a shorter life expectancy for the patient. "End-stage disease" and "poor quality of life" were common explanations for withholding respirator support. Physicians' decisions to intubate were attributed to the perceived "acute reversible" nature of the medical problem.