Clinical ethics

The potential impact of decision role and patient age on end-of-life treatment decision making

¹ VA Health Services Research & Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
² Center for Behavioral and Decision Sciences in Medicine, Ann Arbor, Michigan, USA
³ Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
⁴ Department of Applied Psychology, Bryant University, Smithfield, Rhode Island, USA

Correspondence to:
B J Zikmund-Fisher, Center for Behavioral and Decision Sciences in Medicine, 300 North Ingalls Building, Room 7C27, Ann Arbor, Michigan, 48109-0429, USA; bzikmund{at}umich.edu

Background: Recent research demonstrates that people sometimes make different medical decisions for others than they would make for themselves. This finding is particularly relevant to end-of-life decisions, which are often made by surrogates and require a trade-off between prolonging life and maintaining quality of life. We examine the impact of decision role, patient age, decision maker age and multiple individual differences on these treatment decisions.

Methods: Participants read a scenario about a terminally ill cancer patient faced with a choice between an aggressive chemotherapy regimen that will extend life by two years and palliative treatments to control discomfort for one remaining month. Participants were randomly assigned to one of three decision roles (patient, physician, or an abstract other) and the scenario randomly varied whether the patient was described as 25 or 65-years old.

Results: When deciding for a 65-year old patient, approximately 60% of participants selected aggressive chemotherapy regardless of decision role. When deciding for a 25-year old patient, however, participants were more likely to select chemotherapy for a patient (physician role) or another person (abstract other) than for themselves (70%, 67%, and 59%, respectively). In addition, confidence that powerful others (eg, physicians) control one’s health, as well as respondents’ age and race, consistently predicted treatment choices.

Conclusions: Patient age appears to influence medical decisions made for others but not those that we make for ourselves. These findings may help to explain the discord that often occurs when younger cancer patients refuse life-extending treatments.

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