• advance directives;
  • aged;
  • ethics;
  • decision making;
  • physicians

OBJECTIVES: To assess whether older physicians have discussed their preferences for medical care at the end of life with their physicians, whether they have established an advance directive, and what life-sustaining treatment they wish in the event of incapacity to make these decisions for themselves.

DESIGN: Mailed survey to a cohort of physicians.

SETTING: Physicians who were medical students at the Johns Hopkins University in graduating classes from 1946 to 1964.

PARTICIPANTS: Physicians who completed the advance directive questionnaire (mean age 68).

MEASUREMENTS: Questionnaires were sent out to known surviving physicians of the Precursors Study, an on-going study that began in 1946, asking physicians about their preferences for life-sustaining treatments.

RESULTS: Of 999 physicians who were sent the survey, 765 (77%) responded. Forty-six percent of the physicians felt that their own doctors were unaware of their treatment preferences or were not sure, and of these respondents, 59% had no intention of discussing their wishes with their doctors within the next year. In contrast, 89% thought their families were probably or definitely aware of their preferences. Sixty-four percent reported that they had established an advance directive. Compared with physicians without advance directives, physicians who established an advance directive were more likely to believe that their doctors (odds ratio (OR) = 3.42, 95% confidence interval (CI) = 2.49–4.69) or family members (OR = 9.58, 95% CI = 5.33–17.23) were aware of their preferences for end-of-life care and were more likely to refuse treatments than those without advance directives.

CONCLUSION: This survey of physicians calls attention to the gap between preferences for medical care at the end of life and expressing wishes to others through discussion and advance directives, even among physicians.