Intensive Care Medicine

, Volume 39, Issue 6, pp 1128–1132

The luck of the draw: physician-related variability in end-of-life decision-making in intensive care

Legal and Ethical Issues

DOI: 10.1007/s00134-013-2871-6

Cite this article as:
Wilkinson, D.J.C. & Truog, R.D. Intensive Care Med (2013) 39: 1128. doi:10.1007/s00134-013-2871-6



To critically analyze physician-related variability in end-of-life decision-making in intensive care.


An ethical analysis of factors contributing to physician-related variability in end-of-life decision-making.


There is variability in decision-making about life support, both within and between intensive care units. Physician age, race, religion, attitude to risk, and personality factors have been associated with decisions to provide or limit life-sustaining treatment, though it is unclear how much these factors affect patient outcome. Inconsistency in decision-making appears worryingly arbitrary, and may mean that patients’ values are sometimes being ignored or overridden. However, physician influence on decisions may also sometimes be appropriate and unavoidable, particularly where patient values are unclear.


We argue that, although physician-related variability in end-of-life care can never be eliminated entirely, it is potentially ethically problematic. We outline four potential strategies for reducing the “roster lottery.”


Terminal care/ethics Withholding treatment Intensive care Decision-making Clinical ethics 

Supplementary material

134_2013_2871_MOESM1_ESM.docx (114 kb)
Supplementary material 1 (DOCX 113 kb)
134_2013_2871_MOESM2_ESM.docx (57 kb)
Supplementary material 2 (DOCX 56 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  1. 1.Discipline of Obstetrics and GynecologyWomen’s and Children’s Hospital, University of AdelaideNorth AdelaideAustralia
  2. 2.Oxford Uehiro Centre for Practical Ethics The University of OxfordOxfordUK
  3. 3.Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital BostonHarvard Medical SchoolBostonUSA
  4. 4.Division of Medical Ethics, Department of Global Health and Social MedicineHarvard Medical SchoolBostonUSA

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