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Medizinische Klinik

, Volume 92, Issue 5, pp 255–259 | Cite as

Einstellungen von Ärzten bei der Behandlung inkompetenter Patienten

Ein Ost-West-Vergleich
  • Jörg Richter
  • Martin Eisemann
  • Barbara Bauer
  • Franz Porzsolt
Originalarbeit

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.

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

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. 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. 2.
    American Geriatric Society (ed.): Position statement: Medical treatment decisions concerning elderly persons. Amer. Geriat. Soc., Washington 1990.Google Scholar
  3. 3.
    Arcangelo, V.: Should age be a criterion for rationing health care? Nurs. Forum 29 (1994), 25–29.PubMedCrossRefGoogle Scholar
  4. 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.Google Scholar
  5. 5.
    Clarnette, R. M., D. W. Molloy: Health care directives. Ann. med. Direct. 5 (1991), 48–51.Google Scholar
  6. 6.
    Danis, M.: A prospective study of advance directives for life-sustaining care. New Engl. J. Med. 324 (1991), 882–888.PubMedGoogle Scholar
  7. 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.CrossRefGoogle Scholar
  8. 8.
    Davitt, J. K., L. W. Kaye: Supporting patient autonomy: decision making in home care. Soc. Worker 41 (1996), 41–50.Google Scholar
  9. 9.
    Duffield, P., J. E. Podzamsky: The completion of advance directives in primary care. J. Fam. Pract. 42 (1996), 378–384.PubMedGoogle Scholar
  10. 10.
    Edinger, W., D. R. Smucker: Outpatients’ attitudes regarding advance directives. J. Fam. Pract. 35 (1991), 650–653.Google Scholar
  11. 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. 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.).Google Scholar
  13. 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.Google Scholar
  14. 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.PubMedGoogle Scholar
  15. 15.
    Emanuel, L. L., E. J. Emanuel: The medical directive: a new comprehensive advance document. J. Amer. J. Med. 262 (1989), 3288–3293.CrossRefGoogle Scholar
  16. 16.
    Iserson, K. V.: Getting advance directives to the public: a role for emergency medicine. Ann. Emerg. Med. 20 (1991), 692–696.PubMedCrossRefGoogle Scholar
  17. 17.
    Iserson, K. V.: A simplified prehospital advance directive law: Arizona’s approach. Ann. Emerg. Med. 22 (1993), 1703–1710.PubMedCrossRefGoogle Scholar
  18. 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.Google Scholar
  19. 19.
    Kuuppelomak, M.: Ethical decision making on starting terminal care in different health-care units. J. Advanc. Nurs. 18 (1993), 276–280.CrossRefGoogle Scholar
  20. 20.
    Levinsky, N. G.: Age as a criterion for rationing health care. New Engl. J. Med. 322 (1990), 1813–1816.PubMedCrossRefGoogle Scholar
  21. 21.
    McCormick, R. A.: To save or let to die: the dilemma of modern medicine. J. Amer. med. Ass. 229 (1974), 172–176.CrossRefGoogle Scholar
  22. 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.Google Scholar
  23. 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. 24.
    Molloy, D. W., V. Mepham: Let me decide. Penguin Books, Toronto 1992.Google Scholar
  25. 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. 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.CrossRefGoogle Scholar
  27. 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. 28.
    Noelle-Neumann, E.: Senioren im Pflegemarkt: Die Alten wissen genau, was sie wollen. Pflege-Ztg. 48 (1995), 733.Google Scholar
  29. 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.Google Scholar
  30. 30.
    Schecter, W. P.: Withdrawing and withholding life support in geriatric surgical patients. Ethical considerations. Surg. Clin. N. Amer. 74 (1994), 245–249.PubMedGoogle Scholar
  31. 31.
    Scitovsky, A. A.: The high cost of dying: What do the data show? Milbank Quart. 62 (1984), 591–608.CrossRefGoogle Scholar
  32. 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.PubMedGoogle Scholar
  33. 33.
    Sprung, C. L.: Changing attitudes and practices in forgoing life-sustaining treatments. J. Amer. med. Ass. 263 (1990), 2211–2215.CrossRefGoogle Scholar
  34. 34.
    Thomasma, D. C.: The ethical challenge of providing healthcare for the elderly. Cambr. Quart. Hlth Ethics 4 (1994), 148–162.CrossRefGoogle Scholar
  35. 35.
    Tomlinson, T., H. Brody: Ethics and communication in do-not-resuscitate orders. New Engl. J. Med. 318 (1988), 43–46.PubMedGoogle Scholar
  36. 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. 37.
    Whithe, B. D., P. A. Singer, M. Siegler: Continuing problems with patient self-determination. Amer. J. Med. Qual. 8 (1993), 187–193.CrossRefGoogle Scholar

Copyright information

© Urban & Vogel 1997

Authors and Affiliations

  • Jörg Richter
    • 1
  • Martin Eisemann
    • 2
  • Barbara Bauer
    • 3
  • Franz Porzsolt
    • 4
  1. 1.Klinik für Psychiatrie und Psychotherapie im Zentrum für Nervenheilkunde der UniversitätRostock
  2. 2.Dept. Psychiatry & WHO Collaborating Centre, Unit of Medical PsychologyUmeå UniversitySweden
  3. 3.Neurologische Klinik im Klinikum NeubrandenburgKlinik für Innere Medizin der Universität UlmDeutschland
  4. 4.Klinik für Innere Medizin der Universität UlmDeutschland

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