Palliative medicine: doctors decide about death.
(07.09.2010) Euthanasia is a controversial topic in Germany, in which the basic attitudes and moral convictions of the doctors clash. An anonymous survey by the Ruhr University Bochum (RUB) among members of the German Society for Palliative Medicine has shown that palliative care physicians often accept the patient's previous death as part of symptom relief.
Palliative care physicians accompany patients at the end of their lives and often have to make fundamental ethical decisions that ultimately determine life and death. The focus is not solely on the survival of the patient, but rather the quality of life with the needs, wishes, goals and general condition of the patient must also be taken into account when making decisions. According to the results of the examination, the attending palliative care physicians often accept a shortened lifespan of the patient in order to improve their quality of life a little. However, it could be problematic that the patients were often not informed accordingly.
In addition to the medical survey, 780 deaths were also evaluated. In summary, it can be stated that around three quarters (78 percent) of the patients took measures to alleviate the symptoms in the last phase of life, which shortened the lifespan of those affected. In 69 percent of the cases, medical measures were limited by the medical side, which also reduced the life expectancy of the patients. In ten patients, the doctors even deliberately caused the patient's death, according to the results of the survey. In 47 cases, the doctors did not inform their patients about the possible shortening of the lifespan due to the treatment, although they were self-determined at the time of the decision. The doctors emphasized that they had always had “the best interests of the patient” or “avoiding possible damage” in mind.
From the point of view of Jan Schildmann from the Institute for Medical Ethics at RUB, it is “remarkable that some of the doctors surveyed not only anticipate but intend to shorten their lives as a consequence of medical action”. Especially since the official position of the German Medical Association in its “Principles for Medical Care for the Dying of Death” has so far categorically excluded medical aid for the patient's suicide. However, the current study makes it clear that a different attitude can already be seen in patient care at the end of life. "The official statements on the medical ethics obviously do not correspond to the moral assessments and actions of numerous doctors in Germany," explains study leader Jochen Vollmann up-to-date ethical guidelines for medical action at the end of life should be used ”. The German Hospiz Foundation also sees an urgent need for action based on the study results, since it is a "great danger for all seriously ill" if even specially trained palliative care physicians disregard the patient's will in the form described. In the opinion of the Hospiz Foundation, the German Society for Palliative Medicine and the Federal Medical Association are required to ensure ethical and legal clarity in the medical profession. The managing director of the Hospice Foundation, Eugen Brysch, emphasized that "the right of self-determination of seriously ill people (…) must be respected".
The subject of euthanasia has been hotly debated in the recent past based on the “Living Wills Act”, the case law of the Federal Court of Justice on euthanasia and the cases of euthanasia that have become public. However, the Federal Medical Association has so far not been able to achieve a uniform new line and the previous provisions can no longer apply if a third to a quarter of the treating physicians in practice support the aid to suicide in certain patients. (fp)
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