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Medical Decision Making
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Medical and Nonmedical Determinants of Decision Making about Potentially Life-Prolonging Interventions

Agnes van der Heide, MD, PhD,

Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands; phone: +31 10 4087719; fax: +31 10 4089449a.vanderheide{at}erasmusmc.nl

Astrid Vrakking, MSc

Department of Public Health, Erasmus MC, University Medical Center Rotterdam, the Netherlands

Hans van Delden, MD, PhD

Julius Center for Health Sciences, University Medical Center Utrecht, the Netherlands

Caspar Looman, MSc

Paul van der Maas, MD, PhD

Department of Public Health, Erasmus MC, University Medical Center Rotterdam, the Netherlands

Patient characteristics may influence medical decision making in various ways. The contribution of several patient characteristics to medical decision making was studied. Thirty oncologists, 29 nursing home physicians, and 22 cardiologistswere interviewed (overall response = 60%). Respondents were asked whether they would apply a specified intervention for a number of hypothetical seriously ill patients, who varied with respect to factors thatwere not relevant to the outcome of treatment. The condition that made patients clearly eligible for treatment was kept constant. In amultivariate regression model, patients with a better physical condition, a more obvious social role, and a lower age weremore likely to be treated thanwere other patients. Medical decision making is not exclusively based on empirical evidence but also related to morally complex issues such as patient age and social status.

Key Words: decision making • ethical aspects of decision making • age-based rationing

Medical Decision Making, Vol. 24, No. 5, 518-524 (2004)
DOI: 10.1177/0272989X04268952
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[Abstract] [PDF]