Doctors' attitudes and end-of-life decisions in the elderly: a comparative study between Sweden, Germany and Russia.

The study was performed in order to determine cross-culturally to what extent various attitudes (legal and ethical concerns, hospital costs, level of dementia, patient's age, patient's wishes, family wishes, doctor's religion) influence the treatment decisions of doctors in face of a critically ill incompetent elderly patient. Convenience samples of doctors in Sweden (n=104), Germany (n=191) and Russia (n=232) were surveyed by means of a self-administered questionnaire comprising a case-vignette of an incompetent elderly patient. The importance of various attitudes attributed to the treatment decision varied between countries. The differences were mostly pronounced for the importance of hospital costs (highest in Russia), patient and family wishes (both highest in Sweden) and level of dementia (highest in Sweden). They reflect diverging clinical practice and underlying societal values. They point to the necessity of the development of uniform standards and training of doctors in ethical issues.