[Geriatric health system, economic profit and the debate on euthanasia].
Three characteristic developments in modern western societies usually are considered to be independent variables in the ethical discussion:1. An explosion-like increase in medical and social expenditures following a rapid multiplication of old and multiply disabled people in this century. 2. the increasing economic importance of the "health industry", and 3. the "new" debate of euthanasia. All these developments are discussed controversially. The volume of geriatric support is mostly considered to be insufficient, but usually it is restricted by both, scarcity of resources as well as increasing demands to focus on "evidence-based medicine" (which might exclude a lot of medical procedures in old age). The mutation of health systems from - originally - social activities to business branches more and more gives priority to economical based decisions in medicine, but otherwise has advanced an increasing number of new health professions. The origin of the actual debate on euthanasia is the development and judicial certification of individual's self-determination in modern societies. However, euthanasia is still refused world-wide because it is considered to be linked with a process of weakening basic ethical principles. The 3 seemingly independent developments certainly are facts in modern societies. They hardly can be influenced by the medical profession, being forced to conform to them. However, there are significant connections between them.A geriatric health system, primarily denying individual demands and basic convictions of old people, contributes to an attitude of non-acceptance towards daily practice medicine. The same effect may result from the economic transformation of medicine when creating a system of self-perpetuating demand (being characteristic for an "ideal" business branch) by "unlimited" prolongation of life of the very old and highly disabled patients. The result from this development undoubtedly will be an increasing demand for self-determination at the end of life, including medical assistance in suicide and euthanasia, which cannot successfully be confronted with moral appeals.Alternatively, a basic correction of the geriatric health system must be introduced mainly including psychodynamic factors in medical decision making, or euthanasia will be accepted by the majority, as already has happened in the Netherlands.
Wedler
H
H
Facharzt für Innere und Psychotherapeutische Medizin, Arztlicher Direktor der Medizinischen Klinik 2, Bürgerhospital Stuttgart, Tunzhofer Strasse 14/16, D-70191 Stuttgart.
D000368:Aged; D000369:Aged, 80 and over; D004992:Ethics, Medical; D005065:Euthanasia / Q000331:legislation & jurisprudence*; D005544:Forecasting; D016330:Frail Elderly / Q000706:statistics & numerical data*; D005858:Germany; D015276:Health Care Rationing / Q000639:trends; D005102:Health Expenditures / Q000639:trends; D006299:Health Services for the Aged / Q000191:economics*; D006801:Humans; D009313:National Health Programs / Q000191:economics*