The luck of the draw: physician-related variability in end-of-life decision-making in intensive care

Intensive Care Med. 2013 Jun;39(6):1128-32. doi: 10.1007/s00134-013-2871-6. Epub 2013 Feb 22.


Purpose: To critically analyze physician-related variability in end-of-life decision-making in intensive care.

Methods: An ethical analysis of factors contributing to physician-related variability in end-of-life decision-making.

Results: There is variability in decision-making about life support, both within and between intensive care units. Physician age, race, religion, attitude to risk, and personality factors have been associated with decisions to provide or limit life-sustaining treatment, though it is unclear how much these factors affect patient outcome. Inconsistency in decision-making appears worryingly arbitrary, and may mean that patients' values are sometimes being ignored or overridden. However, physician influence on decisions may also sometimes be appropriate and unavoidable, particularly where patient values are unclear.

Conclusions: We argue that, although physician-related variability in end-of-life care can never be eliminated entirely, it is potentially ethically problematic. We outline four potential strategies for reducing the "roster lottery."

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Advance Directives
  • Attitude of Health Personnel*
  • Decision Making / ethics*
  • Female
  • Humans
  • Intensive Care Units*
  • Male
  • Patient Preference
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / ethics*
  • Terminal Care / ethics*
  • Withholding Treatment / ethics*