Doctors Often Favor Comfort Care Over Life Extension

New Survey Reveals Personal End-of-Life Wishes of Medical Professionals

A global survey indicates that a significant majority of physicians would prioritize symptom management and forgo aggressive life-sustaining treatments for themselves when facing advanced illness, revealing a potential disconnect between medical practice and personal preference.

Preferences Vary by Legal Landscape

The study, encompassing doctors from eight regions with differing laws regarding assisted dying, found that over half would consider assisted dying for themselves, with rates heavily influenced by the legality of such practices in their jurisdiction. Researchers surveyed doctors in Belgium, Italy, Canada, and several states within the US and Australia.

Physician-assisted suicide has been legal in Oregon since 1997, while Canada permits both physician-assisted suicide and euthanasia since 2016. In contrast, Georgia remains one of the most religiously conservative states in the US, where such practices are illegal. Belgium has allowed assisted dying since 2002, while Italy prohibits it.

Limited Desire for Prolonged Treatment

The analysis of 1157 responses revealed a striking reluctance among doctors to pursue life-sustaining interventions for themselves. Only 0.5% considered cardiopulmonary resuscitation (CPR) a good option for advanced cancer, and a mere 0.2% for Alzheimer’s disease. Mechanical ventilation and tube feeding also received extremely low consideration, at 0.8% and 3.5% respectively for cancer, and 0.3% and 3.8% for Alzheimer’s.

Intensified symptom relief was overwhelmingly favored, with 94% and 91% deeming it a good or very good option for cancer and Alzheimer’s, respectively. Palliative sedation also garnered significant support, at 59% and 50% for the two conditions.

Assisted Dying Considerations

Approximately half of respondents indicated they would consider euthanasia a viable option – just over 54% for cancer and 51.5% for Alzheimer’s. Support for euthanasia ranged dramatically, from 38% in Italy to 81% in Belgium for cancer scenarios, and from 37.5% in Georgia to 67.5% in Belgium for Alzheimer’s. Around 33.5% would contemplate using available drugs to end their own life in the event of cancer.

According to the CDC, heart disease remains the leading cause of death in the United States, accounting for nearly 20% of all deaths in 2021 (CDC, 2024). This highlights the relevance of end-of-life care discussions, even outside of cancer or Alzheimer’s diagnoses.

Influence of Legislation and Beliefs

The study demonstrated a clear correlation between prevailing legislation and doctors’ preferences. Physicians practicing in jurisdictions with legal euthanasia and physician-assisted suicide were three times more likely to view euthanasia favorably for cancer and almost twice as likely for Alzheimer’s. Researchers suggest this reflects increased familiarity and comfort with these practices.

“This may be because these physicians are more familiar and comfortable with the practices and have observed positive clinical outcomes. It also suggests that macro-level factors heavily impact personal attitudes and preferences, and physicians are likely influenced by what is considered ‘normal’ practice in their own jurisdiction.”

—Researchers, Journal of Medical Ethics

Doctors who identified as non-religious were significantly more inclined to consider physician-assisted suicide (65% vs 38%) and euthanasia (72% vs 40%) compared to those with strong religious convictions.

Study Limitations and Implications

Researchers acknowledged the study’s limitations, including potential self-selection bias and underrepresentation of GPs in Canada. However, they emphasized the overarching finding: physicians generally prioritize symptom alleviation and avoidance of aggressive life-sustaining measures for themselves.

They suggest this discrepancy between physician preferences and common clinical practice warrants further examination, as life-prolonging treatments remain widely utilized despite not being favored by doctors for their own end-of-life care. This raises questions about potential moral distress experienced by physicians and the need for more patient-centered discussions about end-of-life wishes.