Surgeons don't discuss end-of-life care

According to a recent survey1 published in the Annals of Surgery, many U.S. surgeons fail to discuss their patients' wishes in case a risky operation goes awry, and even more say that they would not operate if patients limited what could be done to keep them alive. The survey indicates that the restrictions are being debated among doctors.

Margaret Schwarze, MD, an assistant professor at the University of Wisconsin School of Medicine and Public Health, Madison, WI, who was one of the survey's authors, said that reportedly, "[surgeons] feel the advance directive basically ties their hands behind their back, and they're not given the tools to get them through the surgery."

The survey's authors asked 912 surgeons who regularly perform risky operations 14 questions on how they discuss a patient's advance directives and whether the directives influence their decision to operate. More than four out of every five surgeons discussed which forms of life support the patients would like to limit. But only about half asked specifically about the patient's advance directive, which can include restricting the use of feeding tubes and ventilators to keep a person alive.

"I think some surgeons just don't discuss advance directives because they think it's so irrelevant," Schwarze added.

More than half the surgeons said they would not operate if an advance directive limited what could be done to keep a patient alive after surgery.

The researchers said such instructions also can cause tension between the surgeon and the patient because it shows the patient might be unwilling to accept the therapies that come with high-risk operations. The study also found that heart surgeons appeared to be much more likely than brain surgeons to decline an operation.


  1. Redmann A, Brasel K, Alexander C, et al. Use of advance directives for high-risk operations: A national survey of surgeons. An Surg 2011; pub ahead of print Dec. 1, 2011. Doi: 10.1097/SLA.0b013e31823b6782.