Therapeutische Umschau. Revue thérapeutique
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Palliative care comprises the complete treatment and care of patients suffering from incurable, life-threatening or chronically progressive disease. The aim is to provide the patients with the best possible quality of life and support them through the course of their illness until their death, to alleviate their suffering as much as possible and in consideration of the social, spiritual and religious aspects according to the patient's wishes. Palliative care is most important when the dying process and the patient's impending death do seem to be inevitable. ⋯ Decisions about life-prolonging measures, treatment of pain, dyspnea and palliative sedation require balancing the burden against the benefits. Decision-making must rest with the patient - as far as possible and as long as possible. The potential life-shortening effect of palliative therapy will need to be considered and discussed.
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Ethics and health economics are often seen as contradictory. Based on new obligations imposed by the Federal Department of Home Affairs demanding ethics and health economics to be both embedded in the medical curriculum we challenge the relationship between the two fields. ⋯ However, medical ethics does not only need to support but to unsettle, too; it will need both to accelerate and to brake. Only a conception of economics which allows for features like deceleration will be able to cope with a patient's needs and only on this basis can ethics fulfil its major task of promoting intentional ethical decision-making in public health organisations that is both structurally efficient and effective.
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Starting with a complex clinical situation we introduce basic concepts of clinical ethics. We explain why well-defined terms are needed and demonstrate how these terms can be used as practical tools for approaching and resolving ethical dilemmas in a professional decision-making process. It will be outlined how the use of these terms may contribute to the understanding of the ways in which moral values are perceived and communication skills can be improved.