Bauer Axel W
Fachgebiet Geschichte, Theorie und Ethik der Medizin, Medizinische Fakultät Mannheim der Universität Heidelberg, Ludolf-Krehl-Strasse 7-11, Mannheim, Germany.
Wien Med Wochenschr. 2007;157(9-10):201-9. doi: 10.1007/s10354-007-0412-z.
During the last decade numerous consultative bodies for bioethical and medical ethical issues have been established. In this study we will introduce the clinical ethics committee (CEC), which can be mainly brought into action for three purposes: discussing moral problems in a hospital's everyday work, developing guidelines for the clinic, and giving further education to the hospital's staff. Starting with the denominational hospitals at the end of the 1990s, CECs have been established in the meantime at a large number of German clinics, often in an interrelation with hospital certification. We will describe the process of establishing a CEC at the university hospital in Mannheim (Baden-Württemberg) and examine its formal structure given by the statutes and the standing orders. An important issue of the CEC's activities consists in individual consultation, for instance concerning withholding or withdrawing life-supporting therapy from comatose patients. First and foremost it has to be clarified whether there is really an ethical problem which cannot be solved by those seeking advice or whether the CEC is just asked a rhetorical question in order to attain allies. In this case disappointment will often be the consequence. The quality of an ethical consultation cannot be treated as equivalent to the correspondence with preconceived moral attitudes. The CEC is not a "moral police" but a multi-professional body, in which scientific medical ethics should play an important but under no circumstances a dominating role. Meaningful criteria and measuring methods to study the effectiveness of clinical ethics committees will have to be evolved and tested in practice as soon as possible.
在过去十年中，已经成立了许多处理生物伦理和医学伦理问题的咨询机构。在本研究中，我们将介绍临床伦理委员会（CEC），它主要可用于三个目的：讨论医院日常工作中的道德问题、制定临床指南以及为医院工作人员提供进一步培训。从20世纪90年代末的教派医院开始，与此同时，德国大量诊所都成立了临床伦理委员会，它们通常与医院认证相关联。我们将描述在曼海姆（巴登 - 符腾堡州）大学医院成立临床伦理委员会的过程，并审视其章程和议事规则所规定的正式结构。临床伦理委员会活动的一个重要问题在于个体咨询，例如关于对昏迷患者停止或撤销维持生命治疗的问题。首先必须明确，是否真的存在寻求建议者无法解决的伦理问题，或者临床伦理委员会是否只是被问及一个修辞性问题以获取支持。在这种情况下，往往会导致失望。伦理咨询的质量不能等同于与先入为主的道德态度的契合度。临床伦理委员会不是“道德警察”，而是一个多专业机构，其中科学的医学伦理应发挥重要但绝不是主导作用。必须尽快在实践中制定并测试用于研究临床伦理委员会有效性的有意义的标准和衡量方法。
