MMW Fortschritte der Medizin
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As a means of achieving a reduction in the amputation rate in patients with a diabetic foot syndrome, the early diagnosis and specialized treatment of peripheral circulatory disorders is of eminent importance. Treatment includes pressure relief, wound cleanup and stage-oriented local wound management, measures to improve circulation, and the appropriate treatment of bacterial infection. Useful preventive measures include the training of diabetics, regular foot care, and the provision of appropriate footwear.
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In Germany, the legal possibilities for withholding or withdrawing life-preserving measures are based on four judgments by the Federal High Court, which forbid both the deliberate killing of a patient and physician-assisted suicide. Life-saving measures may be withheld or withdrawn only when this is in conformity with the declared will of the patient (as expressed, for example, in a living will, or by the patient's proxy), and when death is to be expected within the near future. If the process of dying has already begun, such a decision may be taken even when the expressed will of the patient is not known.
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The medical possibilities of keeping a patient alive with the aid of drugs and technical aids are constantly expanding. A more difficult decision that the care-providing physician is called upon to make is: when is the point reached when further treatment no longer makes sense? From here on, the objective is to enable the patient to die with dignity,which entails allowing him/her and relatives the opportunity to take their leave of one another.