Whether to Offer Interventions at the End of Life: What Physicians Consider and How Clinical Ethicists Can Help.

Abstract

Background: Advances in life-prolonging technologies increasingly create dilemmas for physicians who must decide whether to offer various interventions to patients nearing the end of life. Clinical ethicists are often consulted to support physicians in making these complex decisions and can do so most effectively if they understand physicians' reasons for making recommendations in this context.

Methods: Semi-structured interviews were conducted with surgeons, nephrologists, intensivists, emergency physicians, and oncologists regarding the considerations they have used to make decisions about offering interventions for patients nearing the end of life. Interview transcripts were thematically analyzed.

Results: We identified six types of considerations physicians take into account: (1) patient characteristics at baseline; (2) likelihood to cause harm; (3) likelihood to achieve a goal or perceived benefit; (4) patient and family values and preferences; (5) institutional factors, and (6) professional and personal factors.

Conclusions: While considerations converged into major themes, many participants evaluated and applied these themes differently, opening the door to potential disagreement and variation based on physicians' personal values. Clinical ethicists can help navigate uncertainty and resolve conflicts by helping physicians recognize, evaluate, and communicate their decisional factors to aid informed decision-making.