Results of a comparative investigation in Swedish and German nurses are presented. Based on a case-vignette with three levels of available information about patient wishes the subjects were asked about their decisions. Generally, the Swedish nurses showed a tendency towards less aggressive treatment-options and to perform less frequent cardio-pulmonary resuscitation (CPR) against the patient written will compared with the Germans. The compliance with patient wishes among nurses from both countries was related with the valuation of the patient directive as a useful tool in their decision-making process. Furthermore, the "level of dementia" emerged as a significant predictor of the treatment decision in both groups. The results point to the necessity of continuous education and training of nurses aiming at the issues of ethical attitudes and coping with ethically problematic situations in the treatment of the elderly in order to improve patient autonomy.