Providing or withholding treatment: The role of the patient's wish and priorities in palliative care

Background and objective: Medical law and ethics require that intervention be based on patients' wishes. However, in particular the presumed wish of the patient, is often difficult to establish. Discussions with patients may want to inform or influence the patient's wishes. We investigated how far clinical decisions recognize the patient's wishes and how the presumed wishes of the patient is established and respected. Patients and methods: 503 physicians (25.6% women; mean age 36.3) in 49 departments of the universities Bochum and Magdeburg filled in a validated questionnaire. Results: 86.2% of the physicians questioned ranked the patient's wish as important or very important. However, 54.4% tried to modify it. Advanced directives play the most important role when the patient is unable to communicate. Danger to life and suicide are reasons for clinical decisions against the patient's wishes. But it is the main reason to end a causal therapy in terminally ill patients, especially in experienced physicians' opinion. Conclusions: Patients will plays a prominent role in treatment decisions; Even more so, physicians follow patient's wishes when withholding or withdrawing treatment. Our study could not find out how widely information of the patient plays a role in altering the patient's wishes in a paternalistic manner. Given a relative unfamiliarity with advance directives, affirmative attitudes towards their recognition are remarkable. As far as palliative and comfort care for terminal patients is concerned, contrary to widely voiced concern, clinicians do not have priorities different from those used in hospice care.