Ulsenheimer K
Unfallchirurg. 2009 Nov;112(11):1004-9. doi: 10.1007/s00113-009-1667-1.
Increasing specialization and growing mechanization in medicine have strongly supported the transfer of originally medical responsibilities to non-medical personnel. The enormous pressure of costs as a result of limited financial resources in the health system make the delegation of previously medical functions to cheaper non-medical ancillary staff expedient and the sometimes obvious lack of physicians also gains importance by the delegation of many activities away from medical staff. In the German health system there is no legal norm which clearly and definitively describes the field of activity of a medical doctor. Fundamental for a reform of the areas of responsibility between physicians and non-medical personnel is a terminological differentiation between instruction-dependent, subordinate, non-independent assistance and the delegation of medical responsibilities which are transferred to non-medical personnel for independent and self-determined completion under the supervision and control of a physician. The inclination towards risk of medical activities, the need of protection of the patient and the intellectual prerequisites required for carrying out the necessary measures define the limitations for the delegation of medical responsibilities to non-medical ancillary staff. These criteria demarcate by expert assessment the exclusively medical field of activity in a sufficiently exact and convincing manner.
医学领域日益专业化和机械化，有力地推动了原本由医务人员承担的职责向非医务人员的转移。由于卫生系统财政资源有限而产生的巨大成本压力，使得将以前由医务人员执行的职能委托给成本较低的非医疗辅助人员变得合情合理，而且医务人员有时明显短缺，这也因许多活动从医务人员手中转移出去而变得更加突出。在德国卫生系统中，没有明确而确切地描述医生活动领域的法律规范。医生与非医务人员之间责任领域改革的根本在于，对依赖指令的、从属的、非独立的协助与医疗责任委托进行术语区分，医疗责任委托是指在医生的监督和控制下，将医疗责任转移给非医务人员以便其独立和自主完成。医疗活动的风险倾向、对患者的保护需求以及采取必要措施所需的智力前提，界定了将医疗责任委托给非医疗辅助人员的限制。这些标准通过专家评估以足够精确和令人信服的方式划分出了专属医疗活动领域。
