Doctors' authoritarianism in end-of-life treatment decisions. A comparisonbetween Russia, Sweden and Germany

Objectives-The study was performed in order to investigate how end-of-life decisions are influenced by cultural and sociopolitical circumstances and t o explore the compliance of doctors with patient wishes Participants and measurement-Five hundred and thirty-five physicians were s urveyed in Sweden (Umea), Germany (Rostock and Neubrandenburg), and in Russ ia (Arkhangelsk) by a questionnaire. The participants were recruited accord ing to availability and are not representative. The questionnaire is based on the one developed by Molloy and co-workers in Canada which contains thre e case vignettes about an 82-year-old Alzheimer patient with an acute life- threatening condition; the questionnaire includes different levels of infor mation about his treatment wishes. We have added various questions about at titudes determining doctors' decision making process (legal and ethical con cerns, patient's and family, wishes, hospital costs, patient's age and leve l of dementia and physician's religion). Results-Swedish physicians chose fewer life-prolonging interventions as com pared with the Russian and the German doctors. Swedish physicians would per form cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest l ess frequently, followed by the German doctors. More than half the Russian physicians decided to perform CPR irrespective of the available information about the patient's wishes. Level of dementia emerged as the most powerful determining attitude-variable for the decision making in all three countri es. Conclusions-The lack of compliance with patient wishes among a substantial number of doctors points to the necessity of emphasising ethical aspects bo th in medical education and clinical practice. The inconsistency in the tre atment decisions of doctors front different countries calls for social cons ensus in this matter.