Interpreting “Do not resuscitate”: A cautionary tale of physician influence

Care intensity at the end of life is known to vary across geography and health care systems, yet very little work has identified mechanisms that drive such variation. Existing literature has been unable to attribute such differences consistently to patient characteristics, raising the possibility that individual health care center factors or physicians’ practice patterns drive much of the variation. Indeed, intensive care units (ICUs) vary dramatically in how they manage care for patients with already established preferences for treatment limitations or those facing imminent death, suggesting the existence of local ICU cultures or institutional norms that determine such care. Other studies have demonstrated that individual physicians are associated with decisions to withhold or withdraw life support or in hospice enrollment, even more so than any patient characteristics.