End-of-life decisions: physicians as advocates for advance directives

Physicians have a unique role in supporting patients and families throughout their lives; their expertise is called on not only in life, but also at its end. This study was designed to determine the effect of an individual's age, gender, and attachment to the decision maker with regard to life support choices. A total of 151 subjects completed the researcher-developed instrument. Results suggest that the age of patients is significantly related to the life support options chosen. Specifically, the greater the age of the patient, the more likely a less vigorous life support alternative was chosen. Gender and attachment had no effect on the level of care chosen. Study participants also identified reasons for selecting a particular life support choice for each case. The most common reasons given for a close relative centered around quality-of-life issues. In situations involving a nonrelative, life support decisions were likely to be made using the principle of best interest. The primary care physician has a unique opportunity to initiate discussions about life support issues with patients and families. These decisions must be framed in the context of individual patient expectations and desires throughout the life span.