Abstract
Decisions to withhold or withdraw life-sustaining treatment (LST) precede the majority of ICU deaths. Although professional guidelines generally treat the two as ethically equivalent, evidence suggests withdrawing LST is often more psychologically difficult than withholding it. The aim of the experiment was to investigate whether physicians are more supportive of withholding LST than withdrawing it and to assess how physicians’ opinions are shaped by their religious characteristics, specialty, and experience caring for dying patients. In 2010, a survey was mailed to 2016 practicing US physicians. Physicians were asked whether physicians should always comply with a competent patient’s request to withdraw LST, whether withdrawing LST is more psychologically difficult than withholding it, and whether withdrawing LST is typically more ethically problematic than withholding it. Of 1880 eligible physicians, 1156 responded to the survey (62%); 93% agreed that physicians should always comply with a competent patient’s request to withdraw LST. More than half of the physicians reported that they find withdrawing LST more psychologically difficult than withholding it (61%), and that withdrawing LST is typically more ethically problematic (59%). Physician religiosity was associated with finding withdrawal more ethically problematic, but not with finding it more psychologically difficult. Physicians working in an end-of-life specialty and physicians with more experience caring for dying patients were less likely to endorse either a psychological or an ethical distinction between withdrawing and withholding LST. Most US physicians find withdrawing LST not only more psychologically difficult, but also more ethically problematic than withholding such treatment. Physicians’ opinions are to some extent shaped by their religious characteristics, specialty, and levels of experience caring for dying patients.
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This study was funded by grant support from The John Templeton Foundation. The study sponsor had no involvement in the design of the study; the collection, analysis, and interpretation of the data; the writing of the report; or the decision to submit the paper for publication.
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The authors have no conflicts of interest to disclose. Grace S. Chung declares that she has no conflicts of interest. John D. Yoon declares that he has no conflicts of interest. Kenneth A. Rasinski declares that he has no conflicts of interest.
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Chung, G.S., Yoon, J.D., Rasinski, K.A. et al. US Physicians’ Opinions about Distinctions between Withdrawing and Withholding Life-Sustaining Treatment. J Relig Health 55, 1596–1606 (2016). https://doi.org/10.1007/s10943-015-0171-x
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DOI: https://doi.org/10.1007/s10943-015-0171-x