Möller T, Grabensee B, Frister H
Institut für Rechtsfragen der Medizin, Heinrich-Heine-Universität Düsseldorf, Düsseldorf.
Dtsch Med Wochenschr. 2008 May;133(20):1059-63. doi: 10.1055/s-2008-1077217.
Doctors are often confronted with end-of-life decisions. When deciding on the withdrawal of medical treatment physicians have to consider the legal position. This study was done to evaluated how far doctors at the university medical center in Düsseldorf had acted in conformity with the established case law in Germany.
Between April and August 2006 doctors at the university medical center in Düsseldorf filled in a standardized questionnaire about the decisions they had taken to withdraw life-support treatment.
128 of a total of 512 doctors questioned replied (25 %; 32,8 % females and 67,2 % males) . The survey showed that the judicial decision (that it is not necessary to provide treatment if life-support measures are not indicated) is largely determined by non-medical criteria. The clinical decision by doctors depended mainly on his personal opinion. Furthermore the survey showed that only a few doctors made use of the - lawful - option to withdraw medical treatment when this was not indicated. Finally the survey revealed that, in case of conflict between indication and perceived patients' wishes, the vast majority of doctors behaved in contravention of the decisions established by case law.
There is the need to discuss what non-medical issues should be taken into account when determining the indication of withdrawal of life-support measures. The results also highlighted the uncertainties that exist regarding a doctor's decisions about it. Not only should legislation clarify whether "passive euthanasia" is allowed, but it would also be useful to delegate end-of-life decisions to a review board.
医生常常面临临终决策。在决定停止医疗治疗时，医生必须考虑法律立场。本研究旨在评估杜塞尔多夫大学医学中心的医生在多大程度上遵循了德国既定的判例法。
2006年4月至8月期间，杜塞尔多夫大学医学中心的医生填写了一份关于他们做出停止生命支持治疗决定的标准化问卷。
在总共512名接受询问的医生中，有128人回复（25%；女性占32.8%，男性占67.2%）。调查显示，司法裁决（即如果未表明需要生命支持措施，则无需提供治疗）在很大程度上由非医学标准决定。医生的临床决策主要取决于其个人意见。此外，调查表明，只有少数医生在未表明需要时使用了合法的停止医疗治疗的选项。最后，调查显示，在指征与所感知的患者意愿发生冲突的情况下，绝大多数医生的行为违反了判例法确立的决定。
有必要讨论在确定停止生命支持措施的指征时应考虑哪些非医学问题。研究结果还凸显了医生对此类决策存在的不确定性。不仅立法应明确是否允许“被动安乐死”，将临终决策委托给一个审查委员会也会有所帮助。
