Abstract
Using participant observation and interviews, this research investigated the social-cultural factors that influence decision making in the evaluation and treatment of acute illness in nursing homes. Mental status and cost of care emerged as the predominant factors that influence physicians in the decision-making process. Drawing on some of the principles of distributive justice, it is argued that it is unjust to deny health care to the elderly because of their impaired mental status or a lack of financial resources. Quality of life from the patient's perspective, the patient's and their family's wishes and cultural and individual values must be considered in the decision-making process.
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