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Einstellungen von Ärzten bei der Behandlung inkompetenter Patienten

Physicians’ attitudes toward treatment of incompetent patients — A comparison between East- and West-Germany

Ein Ost-West-Vergleich

  • Originalarbeit
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Zusammenfassung

□ Hintergrund

Behandlungsenscheidungen bei inkompetenten, schwerkranken Patienten stellen den Arzt vor eine Menge schwieriger medizinischer, ethischer und rechtlicher Probleme. Die Faktoren und die Gewichtung der verschiedenen Faktoren, die zu einer solchen Entscheidung beitragen, sind selten untersucht worden.

□ Probanden und Methode

310 Ärzte aus Baden-Württemberg und Mecklenburg wurden mit Hilfe eines Fragebogens untersucht, in dem sie angeben sollten, welche Wichtigkeit acht Faktoren für ihre Behandlungsentscheidungen bei älteren Menschen haben.

□ Ergebnisse

Ethische Faktoren und die Wünsche der Patienten erwiesen sich als die wichtigsten Entscheidungskriterien in beiden Subgruppen. Es wurden aber signifikante Unterschiede gefunden zwischen den Antworten der Ärzte beider Bundesländer in dem Ausmaß, in dem die Faktoren Krankenhauskosten, Patienten- und Familienwünsche, Demenzgrad und Alter der Patienten zu ihren Entscheidungen beitragen.

□ Schlußfolgerung

Die Sozialisation der Ärzte der beiden Stichproben in unterschiedlichen Gesundheits- und Sozialsystemen scheint einer der wichtigsten Gründe für diese verschiedene Bewertung der Faktoren zu sein.

Summary

□ 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-Württemberg (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.

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Literatur

  1. Alemayehu E., D. W. Molloy, G. H. Guyatt, J. Singer, G. Penington, J. Basile, M. Eisemann, P. Finucane, M. E. T. McMurdo, C. Powell, A. Zelmanowicz, J. Puxy, C. Power, L. Vitou, S. A. Levenson, I. D. Turpie: Variability in physicians’ decision on caring for chronically ill elderly patients: an international study. Canad. med. Ass. J. 199 (1991), 1133–1138.

    Google Scholar 

  2. American Geriatric Society (ed.): Position statement: Medical treatment decisions concerning elderly persons. Amer. Geriat. Soc., Washington 1990.

  3. Arcangelo, V.: Should age be a criterion for rationing health care? Nurs. Forum 29 (1994), 25–29.

    Article  PubMed  CAS  Google Scholar 

  4. Broadwell, A. W., E. V. Boisaubin, J. K. Dunn, H. T. Engelhardt jr.: Advance directives on hospital admission: a survey of patient attitudes. Sth. med. J. (Bgham, Ala.) 86 (1993), 165–168.

    CAS  Google Scholar 

  5. Clarnette, R. M., D. W. Molloy: Health care directives. Ann. med. Direct. 5 (1991), 48–51.

    Google Scholar 

  6. Danis, M.: A prospective study of advance directives for life-sustaining care. New Engl. J. Med. 324 (1991), 882–888.

    PubMed  CAS  Google Scholar 

  7. Davison, K. W., C. Hackler, D. R. Caradine, R. S. McCord: Physicians’ attitudes on advance directives. J. Amer. med. Ass. 262 (1989), 2415–2419.

    Article  Google Scholar 

  8. Davitt, J. K., L. W. Kaye: Supporting patient autonomy: decision making in home care. Soc. Worker 41 (1996), 41–50.

    CAS  Google Scholar 

  9. Duffield, P., J. E. Podzamsky: The completion of advance directives in primary care. J. Fam. Pract. 42 (1996), 378–384.

    PubMed  CAS  Google Scholar 

  10. Edinger, W., D. R. Smucker: Outpatients’ attitudes regarding advance directives. J. Fam. Pract. 35 (1991), 650–653.

    Google Scholar 

  11. Eisemann, M.: Medical psychology in Sweden: from Cinderella to a full member of the medical family. In: Brähler, E., J. Schumacher (eds.): Psychologie und Soziologie in der Medizin. Psychosozial-Verlag. Gießen 1996, S. 41–42.

    Google Scholar 

  12. Eisemann, M., J. Richter, B. Bauer, R. M. Bonelli, F. Porzsolt: Doctors’ decision-making in incompetent elderly patients: A comparative study between Austria, Germany (East, West) and Sweden. (submitted in Soc. Sc. Med.).

  13. Elder, N. C., F. D. Schneider, S. C. Zweig, P. G. Peters jr., J. W. Ely: Community attitudes and knowledge about advance directives. J Amer. Board Fam. Pract. 5 (1992), 565–572.

    CAS  Google Scholar 

  14. Emanuel, L. L., M. J. Barry, J. D. Stoeckle, L. M. Ettelson, E. J. Emanuel: Advance directives for medical care — a case for grater use. New Engl. J. Med. 324 (1991), 889–895.

    PubMed  CAS  Google Scholar 

  15. Emanuel, L. L., E. J. Emanuel: The medical directive: a new comprehensive advance document. J. Amer. J. Med. 262 (1989), 3288–3293.

    Article  Google Scholar 

  16. Iserson, K. V.: Getting advance directives to the public: a role for emergency medicine. Ann. Emerg. Med. 20 (1991), 692–696.

    Article  PubMed  CAS  Google Scholar 

  17. Iserson, K. V.: A simplified prehospital advance directive law: Arizona’s approach. Ann. Emerg. Med. 22 (1993), 1703–1710.

    Article  PubMed  CAS  Google Scholar 

  18. Kelner, M., I. L. Bourgeault, P. C. Hebert, E. V. Dunn: Advance directives: the view of health care professionals. Canad. med. Ass. J. 148 (1993), 1331–1338.

    CAS  Google Scholar 

  19. Kuuppelomak, M.: Ethical decision making on starting terminal care in different health-care units. J. Advanc. Nurs. 18 (1993), 276–280.

    Article  Google Scholar 

  20. Levinsky, N. G.: Age as a criterion for rationing health care. New Engl. J. Med. 322 (1990), 1813–1816.

    Article  PubMed  CAS  Google Scholar 

  21. McCormick, R. A.: To save or let to die: the dilemma of modern medicine. J. Amer. med. Ass. 229 (1974), 172–176.

    Article  CAS  Google Scholar 

  22. Meran, J. G.: Patientenverfügung und stellvertretende Entscheidung im klinischen Kontext. Medizinethische Materialien, Heft 93: Patientenverfügung und stellvertretende Entscheidung in rechtlicher, medizinischer und ethischer Sicht. Zentrum für Medizinische Ethik, Ruhr-Universität Bochum 1994, S. 2–19.

  23. Molloy, D. W., G. H. Guyatt, E. Alemayehu, W. E. Mcllory: Treatment preferences, attitudes toward advance directives and concerns about health care. Hum. Med. 7 (1991), 285–290.

    Google Scholar 

  24. Molloy, D. W., V. Mepham: Let me decide. Penguin Books, Toronto 1992.

    Google Scholar 

  25. Molloy, D. W., M. Urbanyi, J. R. Horsman, G. H. Guyatt: Two years experience with a comprehensive health care directive in a home for the aged. Submitted in Research report. Hamilton: McMaster University (1993).

    Google Scholar 

  26. Mower, W. R., L. J. Baraff: Advance directives. Effect of type of directive on physicians’ therapeutic decisions. Arch. interm. Med. 153 (1993), 375–381.

    Article  CAS  Google Scholar 

  27. Murphy, C., M. A. Sweeney: Conflict resolution with the end of life decisions in critical care settings. Medinfo 1995, 8 Pt 2.

    Google Scholar 

  28. Noelle-Neumann, E.: Senioren im Pflegemarkt: Die Alten wissen genau, was sie wollen. Pflege-Ztg. 48 (1995), 733.

    CAS  Google Scholar 

  29. Sam, M., P. A. Singer: Canadian outpatients and advance directives: poor knowledge and little experience but positive attitudes. Canad. med. Ass. J. 148 (1993), 1497–1502.

    CAS  Google Scholar 

  30. Schecter, W. P.: Withdrawing and withholding life support in geriatric surgical patients. Ethical considerations. Surg. Clin. N. Amer. 74 (1994), 245–249.

    PubMed  CAS  Google Scholar 

  31. Scitovsky, A. A.: The high cost of dying: What do the data show? Milbank Quart. 62 (1984), 591–608.

    Article  CAS  Google Scholar 

  32. Smedira, N. G., B. H. Evans, L. S. Grais: Witholding and withdrawal of life support from the critically ill. New Engl. J. Med. 322 (1990), 309–315.

    PubMed  CAS  Google Scholar 

  33. Sprung, C. L.: Changing attitudes and practices in forgoing life-sustaining treatments. J. Amer. med. Ass. 263 (1990), 2211–2215.

    Article  CAS  Google Scholar 

  34. Thomasma, D. C.: The ethical challenge of providing healthcare for the elderly. Cambr. Quart. Hlth Ethics 4 (1994), 148–162.

    Article  Google Scholar 

  35. Tomlinson, T., H. Brody: Ethics and communication in do-not-resuscitate orders. New Engl. J. Med. 318 (1988), 43–46.

    PubMed  CAS  Google Scholar 

  36. Weisensce, M. G., D. K. Kjervik, J. B. Anderson: A tool to assess the cognitively impaired elderly. J. Case Manag. 4 (1995), 29–33.

    Google Scholar 

  37. Whithe, B. D., P. A. Singer, M. Siegler: Continuing problems with patient self-determination. Amer. J. Med. Qual. 8 (1993), 187–193.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Klinik für Psychiatrie und Psychotherapie im Zentrum für Nervenheilkunde der Universität, Gehlsheimer Straße 20, D-18147, Rostock

    Jörg Richter

  2. Dept. Psychiatry & WHO Collaborating Centre, Unit of Medical Psychology, Umeå University, Sweden

    Martin Eisemann

  3. Neurologische Klinik im Klinikum Neubrandenburg, Klinik für Innere Medizin der Universität Ulm, Deutschland

    Barbara Bauer

  4. Klinik für Innere Medizin der Universität Ulm, Deutschland

    Franz Porzsolt

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  1. Jörg Richter
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  2. Martin Eisemann
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  3. Barbara Bauer
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  4. Franz Porzsolt
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Richter, J., Eisemann, M., Bauer, B. et al. Einstellungen von Ärzten bei der Behandlung inkompetenter Patienten. Med. Klin. 92, 255–259 (1997). https://doi.org/10.1007/BF03045076

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