[Limits to the duty to treat in intensive care. 1. Explanation of the guidelines in the DGAI].
Every form of active euthanasia is a punishable offence under sections 216 of the Penal Code; nor is there any ethical justification for it from a medical point of view. The many strands of the movement in favour of making "death on demand" exempt from punishment in Germany as it is in The Netherlands cannot change this. In the area of passive euthanasia the limits of the intensive care team's duty to treat depends on various factors: The patient's declared or assumed wishes. It is not permissible to carry out procedures refused by the patient, even when these alone would make an extension of life possible. The indications for medical treatment. In the twilight zone between life and death, procedures with no prospect of success can no longer help the patient. In these circumstances they are pointless and are not medically indicated. According to Supreme Court rulings, the medical decision on whether to implement procedures designed to extend life or whether to withhold such procedures is based almost exclusively on the wishes or the assumed wishes of the patient, even though interpretation of the "assumed wishes" can be difficult and is quite often liable to subjective influences. The question of using the presence or absence of medical indications for treatment as an objective criterion, in contrast, has so far been disregarded in rulings. If no life-extending procedures are implemented the physician's duty to provide suitable basic care for the patient, in the sense of palliative care, remains. To make decisions easier, the authors discriminate between the essential "ordinary" remedies that must be provided to all patients and the "extraordinary" remedies of intensive care that are available for patients who can still benefit from them. There is some controversy over the correct assignment of artificial nutrition; according to German legislation it belongs in the category of extraordinary remedies. The palliative procedures that make up basic care include adequate pain relief, which can be a form of indirect euthanasia. The Supreme Court has ruled that it is the physician's duty to prescribe adequate pain relief even when it might have the unavoidable side effect of unintentionally accelerating the patient's death.
Opderbecke
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HW
Vorstand des Instituts für Anästhesiologie des Städt.Klinikums Nürnberg.
Weissauer
W
W
D003422:Critical Care / Q000331:legislation & jurisprudence*; D005065:Euthanasia / Q000331:legislation & jurisprudence*; D005066:Euthanasia, Passive / Q000331:legislation & jurisprudence; D005858:Germany; D006801:Humans; D016224:Living Wills; D016312:Treatment Refusal / Q000331:legislation & jurisprudence