Patient Attitudes to Discussing Life-Sustaining Treatment

Medical, ethical, and legal guidelines recommend that decisions about life-sustaining treatment be made jointly by physicians and competent, informed patients.1-4Many patients, however, are incompetent when such decisions must be made.5For these patients, it is recommended that clinicians follow wishes that the patient had previously expressed when competent.1-4Although such advance directives respect patient autonomy, several reservations about them have been raised.2,4,6Patients may not want to discuss life-sustaining treatment in advance, may not deliberate about their preferences, or may change their minds as their disease worsens and decisions become real rather than hypothetical. Physicians may fear that such discussions will cause the patient to become anxious or depressed. Refusal of treatment may be due to reversible medical or psychosocial problems.7To address these issues, we administered questionnaires to outpatients who might require decisions about life-sustaining treatment. PATIENTS AND METHODS The site of the