Doctors' End-of-Life Choices Break the Norm

Medscape

3 days ago

A new survey revealed that most doctors would decline aggressive treatments, such as cardiopulmonary resuscitation (CPR), ventilation, or tube feeding for themselves if faced with advanced cancer or Alzheimer's disease, choosing instead symptom relief and, in many cases, assisted dying.
'Globally, people are living longer than they were 50 years ago. However, higher rates of chronic disease and extended illness trajectories have made end-of-life care the need for improved end-of-life care an issue of growing clinical and societal importance,' the authors, led by Sarah Mroz, PhD, a doctoral researcher with the End‑of‑Life Care Research Group at Vrije Universiteit Brussel and Ghent University, based in Brussels and Ghent, Belgium, wrote.
Physicians play a critical role in initiating and conducting conversations about end-of-life care with patients, whose deaths are often preceded by decisions regarding end-of-life practices. These decisions may include choosing to forgo life-prolonging therapies or opting for treatments that could hasten death. Such choices have a significant impact on individuals, families, and the healthcare system.
'Since physicians have a significant influence on patients' end-of-life care, it is important to better understand their personal perspectives on such care and its associated ethical implications. However, existing studies on physicians' preferences for end-of-life practices are outdated and/or focus on a narrow range of end-of-life practices. Additionally, knowledge on whether physicians would consider assisted dying for themselves is limited, and no international comparative studies have been conducted,' the authors wrote.
To address this gap, the researchers conducted a cross-sectional survey of 1157 physicians, including general practitioners, palliative care specialists, and other clinicians from Belgium, Italy, Canada, the US, and Australia.
Physician Choices
Physicians were surveyed regarding their end-of-life care preferences in cases of advanced cancer and end-stage Alzheimer's disease. Over 90% preferred symptom-relief medication, and more than 95% declined CPR, mechanical ventilation, or tube feeding. Only 0.5% would choose CPR for cancer and 0.2% for Alzheimer's disease. Around 50%-54% supported euthanasia in both cases. Support for euthanasia varied by country, from 80.8% in Belgium to 37.9% in Italy for cancer and from 67.4% in Belgium to 37.4% in Georgia, US, for Alzheimer's disease.
'Physicians practicing in jurisdictions where both euthanasia and physician-assisted suicide are legal were more likely to consider euthanasia a (very) good option for both cancer (OR [odds ratio], 3.1) and Alzheimer's disease (OR, 1.9),' the researchers noted. The results show how laws and culture shape end-of-life choices.
Practice Gap
The article highlights a striking disconnect: While most doctors would refuse aggressive interventions for themselves at the end of life, such treatments are still commonly administered to patients. What explains this gap?
'The gap between doctors' preference for comfort-focused care for themselves and the aggressive treatments they often provide to patients highlights a deeper conflict between personal understanding and professional obligation,' said Andrea Bovero, psychologist at the University Hospital Città della Salute e della Scienza and faculty member in the Department of Neurosciences at the University of Turin, both in Turin, Italy, in an interview with Univadis Italy , a Medscape Network platform.
Physicians, he explained, understand the limits of medical interventions and their real impact on quality of life due to their training and experience. 'When they become patients themselves or must make decisions for loved ones, they tend to choose less invasive options — prioritizing quality of life over simply extending it,' he added.
However, the situation changes when treating patients. Doctors operate within a system that rewards intervention, action, and a 'fight the disease' mindset — often under pressure from families who want every possible option pursued and from the fear of appearing negligent to the patient.
'There's also the fear of legal consequences,' Bovero said. 'This drives a defensive approach to medicine, where taking action feels safer than choosing not to intervene.'
According to Bovero, who was not involved in the study, bridging the gap between what doctors would choose for themselves and what they offer their patients requires a broader rethinking of the healthcare system.
'We need new cultural models, medical education that centers on the individual and the ethics of boundaries, and a healthcare system that prioritizes listening and support,' he said.
Rethinking the Role of Death
Deeper cultural factors influence the choice of end-of-life care. 'In many Western societies, death is still seen as a failure — even in medicine,' Bovero said. This mindset, he explained, contributes to the avoidance of honest conversations about dying and a preference for treatments that delay or deny death.
As a result, physicians are often caught between what they know is clinically appropriate and what social or institutional norms they are expected to follow.
'Regulatory frameworks play a major role in defining what is considered possible or acceptable in end-of-life care,' Bovero said. He emphasized that clear, shared laws on practices, such as deep palliative sedation or euthanasia, could give physicians greater freedom to express and follow care decisions focused on patient comfort and relief.
'In countries where the law explicitly supports patients' rights to palliative care, informed consent, and advance directives, physicians are better positioned to align care with patient values,' Bovero noted. For example, Italy's legislation ensures access to palliative care and upholds the right to refuse treatment or plan future care, which promotes dignity and autonomy at the end of life.
Individualized Care
Good care doesn't always mean curative treatment; it often means focusing on quality of life,' Bovero said. He noted that this mindset becomes evident when healthcare professionals, as patients, opt for palliative care. However, he cautioned that physicians' personal preferences shouldn't be applied as a universal standard, because 'every patient has unique values, priorities, experiences, and goals that must be acknowledged and respected.'
Placing the individual at the center of care is fundamental. Bovero emphasized that good clinical practice involves tailoring medical knowledge, evidence, and even a clinician's personal insights into the specific needs of each patient.
Good communication between doctors and patients is key to providing thoughtful care to patients. From the beginning, there should be open, honest discussions between healthcare providers, patients, and families. It is not enough to list treatment options; doctors need to understand what truly matters to the patient, including their fears, desires, and values.
This kind of communication requires time, empathy, and real listening qualities that are often overlooked in health systems prioritizing efficiency and technical fixes.
'When doctors and patients connect not only on a medical level but also around personal meaning and existential priorities, care becomes truly personalized,' Bovero said. His research, published in the Journal of Health Psychology , highlights the importance of addressing patients' spiritual needs and encouraging providers to reflect on their own spirituality to improve support for people at the end of life.