[Who makes decisions--the dilemma of decision-making within the framework of job-sharing in a hospital].
By means of a case report on a 44-year-old female patient, we show how, with changing personnel and places of care, decisions as well as the kind of decision-making during illness influence the quality of care. The patient was receiving immunosuppressive therapy after kidney transplantation and then suffered from a carcinomatous ovary. At first she refused postoperative chemotherapy, but then returned with a very advanced state of metastatic growth. The lack of continuity, a missing overall interdisciplinary concept of medical case, as well as the failure to document decision processes and the patient's attitude to life and suffering made it difficult for the caring team to accompany her in the last weeks of life. A possible solution to such a complex problem will be the introduction of ethical case deliberation.
Voglmayr
Elisabeth
E
Palliativstation des Krankenhauses der Elisabethinen, Linz, Osterreich. elisabeth.voglmayr@elisabethinen.or.at
Widder
Joachim
J
D000230:Adenocarcinoma / Q000556:secondary* / Q000628:therapy*; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D003142:Communication; D003299:Cooperative Behavior; D003657:Decision Making / Q000941:ethics; D016889:Endometrial Neoplasms / Q000628:therapy*; D004992:Ethics, Medical; D005260:Female; D006417:Hematuria / Q000628:therapy; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000941:ethics; D007400:Interprofessional Relations / Q000941:ethics; D009378:Neoplasms, Multiple Primary / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000628:therapy*; D059408:Pain Management; D010166:Palliative Care / Q000941:ethics / Q000379:methods*; D010348:Patient Care Team / Q000941:ethics; D010358:Patient Participation; D001749:Urinary Bladder Neoplasms / Q000556:secondary* / Q000628:therapy*
D000701:Analgesics, Opioid