BACKGROUND: Health care decision-making in incompetent severely ill patients presents a number of difficult medical, ethical and legal problems for the physician. The factors and the degree to which various factors contribute to such decisions have rarely been investigated. SUBJECTS AND METHODS: 310 physicians from the state of Baden-Württernberg (Western Germany) and the state of Mecklenburg (eastern Germany) were asked by means of a questionnaire to rate the importance of eight factors in their health care decisions in the elderly. RESULTS: Both, ethical concerns and patients' wishes emerged as the most important factors for decisions in both subsamples. However, significant differences in the degree to which the factors hospital costs, patients' and family wishes, the level of dementia and the patients' age contribute to their decisions could be found between the answers of the doctors of the two lands. CONCLUSIONS: The socialization of the physicians in different health care and social systems seems to be one of the most important reasons for different health care decisions in old and incompetent patients.
BACKGROUND: Health care decision-making in incompetent severely ill patients presents a number of difficult medical, ethical and legal problems for the physician. The factors and the degree to which various factors contribute to such decisions have rarely been investigated. SUBJECTS AND METHODS: 310 physicians from the state of Baden-Württernberg (Western Germany) and the state of Mecklenburg (eastern Germany) were asked by means of a questionnaire to rate the importance of eight factors in their health care decisions in the elderly. RESULTS: Both, ethical concerns and patients' wishes emerged as the most important factors for decisions in both subsamples. However, significant differences in the degree to which the factors hospital costs, patients' and family wishes, the level of dementia and the patients' age contribute to their decisions could be found between the answers of the doctors of the two lands. CONCLUSIONS: The socialization of the physicians in different health care and social systems seems to be one of the most important reasons for different health care decisions in old and incompetent patients.