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Doctors of elderly patients who are incapable of making decisions are more likely to choose treatment that they believe is in the best interest of their patients, and not necessarily the treatment their patients would have wanted.

Roughly 33% of the 281 physicians surveyed by researchers at the Indiana University School of Medicine identified “what was best for the patient overall” as the most important factor in making decisions for their patients. “What the patient would have wanted you to do” came in a close second, with 29% of doctors using that philosophy as their guiding principle, the report found. Standard ethics models say patient preference is the most important factor, but researchers noted that physicians must weigh a number of options, including family wishes, living wills and patient prognosis.

A doctor’s willingness to rely on the personal wishes of a patient who is no longer able to make decisions decreases with the patient’s age, the report found. One possible explanation for this trend could be that physicians understand that death is an unavoidable event and that for many elderly patients, healthcare should focus more on quality of life than extension of life, report authors suggested. But they also acknowledged it could simply be the arrogance of youth. The report appears in the March issue of the Journal of the American Geriatrics Society.