Objective:To assess the influence of patient access to a private attending physician on the withdrawal of life-sustaining therapies in a medical intensive care unit (ICU).Design:Prospective cohort study.Setting:A university-affiliated teaching hospital.Patients:A total of 501 consecutive patients admitted to the medical ICU during a 5-month period.Interventions:NoneMeasurements and Main Results:Among patients dying in the medical ICU, those without a private attending physician (n = 26) were statistically more likely to undergo the active withdrawal of life-sustaining therapies than patients with a private attending physician (n = 87) (80.8% vs. 29.9%; relative risk = 2.70; 95% confidence interval = 1.86−3.92;p< .001). Despite having similar predicted mortality rates by Acute Physiology and Chronic Health Evaluation II score (60.5% ± 27.0% vs. 66.1% ± 21.3%;p= .280), patients dying in the medical ICU without a private attending physician had statistically shorter hospital and ICU lengths of stay, a shorter duration of mechanical ventilation, and fewer total hospital costs and charges compared with patients with access to a private attending physician. Multiple logistic regression analysis, controlling for severity of illness, demographic characteristics, and patient diagnoses, demonstrated that lack of access to a private attending physician (adjusted odds ratio = 23.10; 95% confidence interval = 9.10−58.57;p< .001) and the presence of a do-not-resuscitate order while in the ICU (adjusted odds ratio = 7.33; 95% confidence interval = 3.69−14.54;p= .004) were the only variables independently associated with the withdrawal of life-sustaining therapies before death.Conclusions:Patients dying in a medical ICU setting without access to a private attending physician are more likely to undergo the active withdrawal of life-sustaining therapies before death than patients with a private attending physician. Health care providers should be aware of possible variations in the practice of withdrawal of life-sustaining therapies in their ICUs based on this patient characteristic.