Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen
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Z Evid Fortbild Qual Gesundhwes · Jan 2008
[A satisfied patient--a good doc? To what extent is patient satisfaction an indicator of quality in general practice? A systematic review].
"How can I find a good doctor?" is one of the most frequent requests patients' help desks receive. The aim of the present study is to appraise whether current available patient satisfaction surveys reflect the quality of ambulatory care from the patients' perspective, and whether this information can be used to choose an adequate care facility. ⋯ Patient satisfaction is an aspect of ambulatory care. However, quality of ambulatory care is not reflected by patient satisfaction alone. Evidence-based information is decisive for the patient's judgement of the quality of medical care. The instruments analysed cannot be used to answer the question: "Is this a good doctor?", unless they consider the availability of adequate patient information.
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Draft versions presented by the Federal Ministry of Justice and proposals submitted from the political parties represented in the German Bundestag as well as an alternative draft issued by criminal law teachers and a decision of the German Lawyers and Law Teachers Association (Deutscher Juristentag) all seek to achieve a legal regulation of euthanasia. Contrary to the regulation in the Netherlands, the prohibition of active direct euthanasia is largely maintained. The drafts suggest that the so-called passive euthanasia and the indirect euthanasia be regulated through provisions for the termination and/or limitation of life-sustaining measures and the permission for measures that alleviate pain and suffering regardless of the risk of bringing about death. ⋯ The advance directive alone lacks sufficient regulation though. It should be permitted, but is no more than a means of "transport". What is to be "transported" as the patient's will at the end of his or her life, however, requires regulation, too.
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Z Evid Fortbild Qual Gesundhwes · Jan 2008
[The desire to depart from life with dignity--an approach to physician-assisted suicide].
"Sentenced to life". In German newspaper and journal articles as well as on television a controversial debate has emerged about the right-to-die. In history and many Western countries people have always been discussing assisted suicide. ⋯ According to these data, there was no slippery slope. In addition, no philosophical arguments can be put forward for the absolute prohibition against suicide of the terminally ill. This should give impetus to efforts to find solutions for the patients in all Western countries.
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Z Evid Fortbild Qual Gesundhwes · Jan 2008
[Physician assistance in dying or help to die--a line of legal demarcation (from the lawyer's perspective)].
The definition of the legal prerequisites for the permissible withholding/withdrawal of medical treatment, the limits to a physician's obligation to provide medical care as well as the differentiation between the aiding with suicide, which is exempt from punishment, and the punishable termination of life upon request or failure to render assistance is actually one of the most difficult medico-legal, professional-ethical, human, ideological and moral problems. The numerous views and opinions expressed are varying accordingly so that the call for legislative action comes as no surprise. Nonetheless, legal practice has provided clarity for a large number of aspects. ⋯ In this context the permissible ,,assistance in dying", i.e., the actual euthanasia, has to be distinguished from ,,help to die", that is, euthanasia in a broader sense, as the Federal Supreme Court (BGH) correctly pointed out in its leading decision (BGHSt 40, 257 et sqq.). Within this differentiation the advance directive is of particular importance since only subsidiary reference may be made to the ,,presumed will or consent" of the patient and, if this cannot be identified, to "general values" for the physician's decision-making. If the patient's will or the general values cannot be identified unambiguously, the protection of life must take priority with the patient's physician, his relatives or his guardian, unless there is no medical indication for the respective treatment procedure.