Farber Neil J, Simpson Pamela, Salam Tabassum, Collier Virginia U, Weiner Joan, Boyer E Gil
Department of Medicine, Christiana Care Health System, Wilmington, Delaware 19899, USA.
Arch Intern Med. 2006 Mar 13;166(5):560-4. doi: 10.1001/archinte.166.5.560.
Few data are available about physicians' decisions in regard to withholding or withdrawing life-sustaining measures. We therefore studied internists' views on this subject.
We surveyed 1000 generalist and subspecialist internists about their views on withholding or withdrawing life-sustaining treatment. Thirty-two hypothetical cases were included. The effect of the demographic data on withholding or withdrawing treatment was analyzed via analysis of covariance and multiple logistic regression.
Of 1000 internists, 407 (41%) completed and returned surveys. A majority of respondents (51%) were willing to withhold or withdraw treatment in all 32 scenarios; 49% were unwilling to withhold or withdraw in at least 1 scenario. Respondents were likely to withhold treatment in 14 of 16 scenarios compared with 13.7 of 16 scenarios for withdrawing treatments (P<.001). Respondents withheld or withdrew feeding tubes in 6.6 of 8 scenarios (P<.001) and antibiotics in 6.7 of 8 scenarios (P = .001) compared with ventilators (7.1 of 8 scenarios) and dialysis (7.3 of 8 scenarios). Respondents were less likely to withhold or withdraw treatments in nonterminally ill (12.9 of 16 scenarios) (P = .02) and alert patients (13.2 of 16 scenarios) (P<.001) compared with terminally ill patients (14.9 of 16 scenarios) and patients with dementia (14.5 of 16 scenarios).
A large percentage of internists would be unwilling to adhere to some of patients' wishes to withhold or withdraw life-sustaining treatment. The clinical scenario and type of treatment affect internists' decisions about whether they would withhold or withdraw such treatment.
关于医生在放弃或撤销维持生命措施方面的决策，可用数据较少。因此，我们研究了内科医生对此问题的看法。
我们就放弃或撤销维持生命治疗的看法，对1000名普通内科医生和专科内科医生进行了调查。纳入了32个假设病例。通过协方差分析和多元逻辑回归分析人口统计学数据对放弃或撤销治疗的影响。
1000名内科医生中，407名（41%）完成并返回了调查问卷。大多数受访者（51%）愿意在所有32种情况下放弃或撤销治疗；49%的人在至少1种情况下不愿意放弃或撤销治疗。与16种情况中的13.7种相比，受访者在16种情况中的14种可能会放弃治疗（P<0.001）。与呼吸机（8种情况中的7.1种）和透析（8种情况中的7.3种）相比，受访者在8种情况中的6.6种会放弃或撤销喂食管（P<0.001），在八项情况中的6.7种会放弃抗生素（P = 0.001）。与晚期患者（16种情况中的14.9种）和痴呆患者（16种情况中的14.5种）相比，受访者在非晚期患者（16种情况中的12.9种）（P = 0.02）和清醒患者（16种情况中的13.2种）（P<0.001）中放弃或撤销治疗的可能性较小。
很大一部分内科医生不愿意遵从患者放弃或撤销维持生命治疗的某些意愿。临床情况和治疗类型会影响内科医生关于是否放弃或撤销此类治疗的决策。
