Neitzke Gerald
Anasthesiol Intensivmed Notfallmed Schmerzther. 2019 Jul;54(7-08):474-483. doi: 10.1055/a-0821-6772. Epub 2019 Jul 25.
It is legally required to determine and respect patient preferences and wishes as much as possible under the circumstances given. This also applies to emergency medicine and intensive care, particularly if a patient is unconscious and is not able to give his consent by him-/herself. According to German law, patients' explicit written statements (advance directive, living will) are mandatory. If no advance directive is available, or if the directive does not match the current medical circumstances, other (oral) statements of the individual patient have to be scrutinized to identify presumed wishes and establish presumed consent. Such wishes are equally binding. The article explicates the role of legal proxies (legal guardians, patient representatives) in determining patients' wishes. Detailed instructions and recommendations are given to medical staff on how to support legal representatives and next of kin with respect to shared decision-making and the process of determining patient preferences. This way, patient autonomy and patients' rights can be protected best.
在给定的情况下，法律要求尽可能确定并尊重患者的偏好和意愿。这同样适用于急诊医学和重症监护，特别是当患者失去意识且无法自行给予同意时。根据德国法律，患者明确的书面声明（预先指示、生前遗嘱）具有强制性。如果没有预先指示，或者该指示与当前医疗情况不符，则必须仔细审查患者个人的其他（口头）声明，以确定推定意愿并确立推定同意。此类意愿同样具有约束力。本文阐述了法定代理人（法定监护人、患者代表）在确定患者意愿方面的作用。就如何在共同决策和确定患者偏好的过程中支持法定代表人和近亲向医务人员给出了详细的指导和建议。通过这种方式，可以最好地保护患者自主权和患者权利。
