Physicians’ attitudes towards living wills and cardiopulmonary resuscitation |
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Authors: | Dr Louis L Brunetti MD JD Stephanie D Carperos MD Ronald E Westlund MS MBA |
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Institution: | (1) the Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina;(2) Department of Internal Medicine, Carolinas Medical Center, Box 32861, 28232-2861 Charlotte, NC |
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Abstract: | Objective:To determine whether a physician’s familiarity with the living will directly relates to an expressed willingness to discuss
resuscitation issues with patients.
Design:Survey of selected primary care and medical subspecialist physicians most likely to care for seriously or terminally ill patients.
Setting:Private-practice clinicians practicing in an urban county.
Participants:Internists, family practitioners, cardiologists, oncologists, and neurologists in private practice.
Interventions:None.
Results:Almost all responding physicians (97.2%) knew of the living will, although few (13.5%) had executed one for themselves. Most
were willing to keep a copy of their patients’ living wills with their office records. However, only a few physicians (20%)
indicated they routinely discussed extraordinary care issues with their patients. In fact, most (70%) reported they rarely
or never discussed cardiopulmonary resuscitation (CPR) with their patients. With terminally ill patients, physician initiative
was greater: 69% reported discussing resuscitation preferences. Comparable discussions with elderly patients were undertaken
only if the physician believed they would be warranted by the clinical circumstances. When questioned about their own sentiments
towards resuscitation, most physicians indicated they would not want CPR if they were terminally ill (86%) or mentally incompetent
(93%). A similar number (92%) would refuse artificial feeding if permanently comatose.
Conclusions:Many physicians recognize the importance of living wills as an expression of patient treatment preferences. Nevertheless,
discussion of patient preferences is unlikely because of physicians’ reluctance, except in limited circumstances, to initiate
a dialogue about life-sustaining measures. Because patients also are often unwilling to begin such discussions, better methods
of facilitating discussion of CPR and other extraordinary health care measures must be sought.
Presented at the Southern Regional Meeting of the Society of General Internal Medicine, New Orleans, Louisiana, January 19,
1990.
Supported by a grant from the Charlotte-Mecklenburg Health Services Foundation, Inc. |
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Keywords: | living wills cardiopulmonary resuscitation advance care directives forgoing life-support physician-patient communication |
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