To determine whether physician attitudes toward decision making in the care of critically ill patients have changed, a survey of physicians was conducted in 1981 and repeated in 1988. Physicians in 1988 were more comfortable discussing "do-not-resuscitate" options with patients and were more likely to allow a critically ill patient to die if the patient so requested. Most physicians in both surveys believe that treatment costs should not play a role in medical decisions. Trainees in 1988 were more aggressive in their management of case studies than were faculty in 1988 or trainees in 1981. While in both years the most important factors in the decision to treat aggressively were a patient's expressed desire to live or die and the amount of patient suffering, physicians in 1988 ranked malpractice concerns as a more important determinant in their decision process compared with physicians in 1981. Significant changes in physician attitudes toward the care of critically ill patients have occurred during this decade.