When patient and doctor disagree

Physician practice in the area of end-of-life care has been shown in previous investigations to vary considerably. In the study by Sprung and colleagues,1 religion of the practitioner and geographic location had a material influence on end-of-life decisions. In the Canadian single-payer system, patients in intensive care have little or no ability to select the intensive care unit (ICU) doctor. Patients wrongly assume that all ICU doctors are equivalent with respect to important decision-making. Turgeon and colleagues2 reveal that which week a patient arrives in the ICU might mean the difference between life and death. Doctors spin powerfully and patients and families believe that the choice before them is the only one. The withdrawal of treatment is treatment, and as such, requires consent. What obligations do doctors have to reveal their biases? When faced with patient–physician conflict, what is the doctor’s obligation to set aside biases when patients are powerless to seek care from an alternate physician whose views on end-of-life care may more closely match their own?