ICU doctors would reject life support for themselves far more than for patients

A French hospital survey has uncovered a striking gap between how intensive care doctors say they would want to be treated at the end of life and how they actually treat their patients. Researchers surveyed 743 hospital professionals—195 ICU caregivers, 349 non-ICU medical staff, and 199 administrative workers—asking them to respond to nine clinical scenarios involving life-sustaining treatment decisions. Each scenario presented different combinations of mortality risk and long-term consequences like prolonged hospitalization or permanent functional dependence. Participants indicated whether they would continue or withdraw treatment for themselves, and separately, what they believed their colleagues would do for a patient in the same situation.

The findings reveal a profession caught between two different moral frameworks. When ICU caregivers considered their own end-of-life care, they prioritized functional dependence and quality of life far more heavily than mortality risk alone. In seven of the nine scenarios tested, they said they would withdraw life-sustaining treatment for themselves more often than they perceived their colleagues actually withdrawing it for patients. This suggests that ICU doctors, having witnessed prolonged suffering and dependence firsthand, develop a personal threshold for acceptable outcomes that differs markedly from the decisions they make in clinical practice.

The gap is particularly pronounced in specific scenarios. In one involving prolonged hospitalization and burden on family members, ICU caregivers were significantly more likely than other hospital professionals to choose withdrawal for themselves. Yet in a scenario presenting high mortality risk, they were less likely to withdraw—suggesting their decision-making is more nuanced and context-dependent than a simple "always pursue aggressive care" or "always let go" approach. This flexibility in their own preferences contrasts with what appears to be a more standardized approach in their clinical work.

Perhaps most striking is what the survey reveals about advance planning. Despite universal awareness of advance directives—every ICU caregiver surveyed knew such documents existed—only 13.3 percent had actually written one. This disconnect between knowledge and action suggests that even professionals who spend their careers managing end-of-life decisions struggle to apply that clarity to their own mortality. They understand the stakes. They know what they want. Yet they do not document it.

The researchers note that long-term consequences influenced all groups' decisions more than mortality risk, but this effect was strongest among ICU caregivers. A patient who will survive but remain severely dependent appears to weigh more heavily in their thinking than a patient facing certain death. This inversion of the typical hierarchy—where survival is usually the paramount concern—hints at how professional experience reshapes moral intuition. Watching people live in states of profound dependence changes what you fear.

These findings raise uncomfortable questions about the relationship between professional culture and clinical judgment. If ICU doctors would make different choices for themselves than they make for patients, whose values are actually driving the decisions made in intensive care units? The study suggests that institutional norms, training, and the weight of precedent may be pulling clinical practice away from what individual caregivers, in their most honest moments, would want for themselves. The authors argue that treatment decisions need better alignment with what patients actually value—not what the system defaults to, and not what professionals assume is standard. Until that alignment happens, the gap between personal preference and clinical practice will remain, a quiet indictment of how institutions can drift from the people they employ and the people they serve.