Gibt es eine ärztliche Verpflichtung zu Gesprächen über Entscheidungen am Lebensende?

Hintergrund: Wenn Entscheidungen am Lebensende rechtzeitig thematisiert und Patientenwünsche z. B. im Rahmen von Advance Care Planning vorausverfügt werden, profitieren die Patienten, ihre Angehörige und auch die behandelnden Ärzte. In der klinischen Realität finden solche Gespräche dennoch häufig n...

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Bibliographic Details
Main Author: Fries, Hansjakob
Contributors: Seifart, Carola (PD Dr. med.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2020
Online Access:PDF Full Text
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Background: Timely conversations about End-Of-Life-Decisions and advance care planning have shown benefits for patients, their relatives and treating physicians. Yet, in the reality of clinical care these conversations often do not take place. It has been debated, that some patients intentionally forfeit their right to self-determination at the end of their lives. Aim: To empirically answer the question whether patients value and actualise autonomy at the end of life. To normatively analyse, whether physicians can be obliged to talk about End-Of-Life-Decisions. To develop a guideline, for approaching patients that do not wish to talk about the topic. Methods: Investigation of a survey of 196 cancer patients regarding their wishes concerning conversations about End-Of-Life-Decisions and bioethical analysis of the findings, with special regard to the concept of personal autonomy by Quante. Results: Autonomy was valued by 95,4 % as an abstract good, conversations about EndOf-Life-Decisions with a physician were held to high regard by 94,2 % of participants. Participants generally preferred shared decision making at the end of life, while those with an incurable disease were more likely to delegate End-Of-Life-Decisions to others. 30,6 % of participants had put up an advance directive, while only 24,7 % had talked to a physician about End-Of-Life-Decisions. 29,6 % of the participants did not want to be approached about the topic. Discussion: There is discrepancy between the wish for self-determination/participation and a lack of patient-physician-communication about the topic. Patients with a life expectancy lower than 12 months should be offered conversations about End-Of-Life-Decisions by their physicians. The obligation to effectively have this conversation is limited by the patients’ autonomy: The waiver of patients that do not wish to talk about the topic should be discussed and critically reflected upon with them. The accompanying offer of trust should be picked up and conversations should be offered repeatedly.