Der Nervenarzt
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In modern medicine, decisions about the kind of treatment at life's end are often inevitable. According to German law, powers of attorney and advance directives can be of help in these decisions. When a patient in a state of competence has issued a lasting power of attorney, there is no need for courts to appoint a proxy, and physicians immediately have a legally empowered decision-maker they can address. ⋯ They are, however, more powerful when issued after consultation with a physician. If treatment at life's end no longer complies with the patient's will or loses its medical indication, the goal of treatment should be redirected towards palliation. This implies that life-sustaining treatment may be withdrawn or withheld, which is best accomplished with sensitivity to the needs of patients, relatives, and health care professionals.
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[The Erlangen examination. An alternative to multiple choice testing for German neurology students].
With the latest revision of the German Medical Licensing Regulation in 2002, educating faculties gained more freedom in the organisation and assessment of trainees. The Erlangen Neurological Exam Structured (ERNEST) is an alternative for assessing competency in clinical knowledge at the end of the neurological general education. The answers must be given in written, short essay format. ⋯ The ERNEST is a viable alternative form of assessment as compared to the conventional MC exam. The basic quantitative parameters of the assessment comply with the requirements of medical assessments. The students evaluated ERNEST as mainly positive.
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The principle of informed consent to invasive diagnostic or therapeutic procedures is not applicable in most patients suffering from consciousness disorders. As in other medical situations, German law assigns priority to the patient's autonomy and employs the concept of presumed will inferred from third-party (e.g. relatives) communications or deduced from a living will. While discussion concerning the validity of such advance directives is ongoing, their applicability needs to be checked carefully in every case. ⋯ In clinical practice, efforts to deduce the patient's will must relate to the urgency and invasiveness of the intended medical procedures. This paper describes the framework of current legal rules and important case decisions involved in the process of decision-making for patients unable to give informed consent. Any such decisions must be documented comprehensively in hospital records.