Palliative care physicians decide on death

Palliative medicine: doctors decide on death.

(07.09.2010) Euthanasia is a controversial subject in Germany, in which the principles and moral convictions of physicians clash. For example, an anonymous survey conducted by the Ruhr-Universität Bochum (RUB) among members of the German Society for Palliative Medicine has shown that palliative care physicians often accept the patient's earlier death as part of symptom relief.

Palliative care professionals accompany patients at the end of their lives and often make fundamental ethical decisions that ultimately determine life and death. It is not only the survival of the patient in the foreground, but the quality of life with the needs, desires, goals and general well-being of the patient are also to be considered in the decisions. Thus, the attending palliative care physicians often accept a shortened lifetime of the patients as a result of the results of the investigation in order to increase their quality of life a little. However, it could be problematic that patients were often not informed accordingly.

In addition to the survey of physicians and 780 deaths were evaluated. In summary, approximately three-quarters (78%) of patients in the last phase of their lives took measures to alleviate the symptoms, which shortened their lives. In 69 percent of the cases, the 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 death of the patient, according to the results of the survey. In 47 cases, the doctors did not inform their patients about the possible reduction in the duration of treatment, even though they were self-determined at the time of the decision. The doctors emphasized that they always „the best interest of the patient“ respectively „the avoidance of possible damage“ had in mind.

It is also from the point of view of Jan Schildmann of the Institute for Medical Ethics of the RUB „noteworthy that some of the physicians surveyed not only foresaw shortening life as a consequence of medical action, but intended it”. Especially as the official position of the German Medical Association in their „Principles of medical care“ a medical aid for suicide of the patient so far categorically excludes. However, the present study makes it clear that in practice a different attitude can already be seen in patient treatment at the end of life. „The official statements on medical etiquette do not seem to agree with the moral evaluations and actions of numerous doctors in Germany“, explains study director Jochen Vollmann.and also emphasizes that „the new empirical research results (...) will be used as the basis for an honest debate on contemporary ethical guidelines on medical care at the end of life“ should. The German Hospice Foundation also sees an urgent need for action on the basis of the study results, as it has a „great danger for all the seriously ill“ even if specially trained palliative care physicians disregard the patient's will in the described form. In the opinion of the Hospice Foundation, the German Society for Palliative Medicine and the German Medical Association are called upon to ensure ethical and legal clarity in the medical profession. The Executive Hospice Foundation Board Eugen Brysch underlined that „to respect the right of self-determination of seriously ill people (...)“ is.

The topic of euthanasia has recently been based on the „Living Will Act“, The case-law of the Federal Court on euthanasia and the cases of medical euthanasia that have become public have been hotly debated time and again. However, the German Medical Association has not yet been able to reach a uniform new line and the previous stipulations can no longer apply if one third to one quarter of the physicians in practice advocate assisting suicide in certain patients. (Fp)

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Image: D. Braun