Therapeutische Umschau. Revue thérapeutique
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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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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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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.
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Often, patients with neurological diseases need to undergo surgical procedures. The most frequent are orthopaedic surgery (tenotomies, corrections of articulations), urological procedures (for instance, sphincter surgery for urinary incontinence), ENT surgery (tracheotomy), or plastic surgery for closure of decubitus ulcers. Preoperatively, these patients need a careful check-up including a thorough drug history. ⋯ A close collaboration between general practitioner and anaesthesiologist is warranted. It cannot be excluded that symptoms of the neurological disease will deteriorate postoperatively due to anaesthesia, surgery or perioperative stress. Medication that is used to control symptoms of a neurological disease should not be stopped in the perioperative period.
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Anaesthetists often visit their patients in exceptional situations characterised by preoperative anxiety or distress. Therefore, even brief contact with the patient can be considered intense and meaningful. The initial preoperative anaesthetic visit is the beginning of the relationship between patient and anaesthetist, and should help to explain the planned anaesthetic technique. ⋯ Today, there is in general a shift away from decisions made solely by physicians, reflecting an increased respect for the autonomy of the patient towards a model of shared decision-making and informed choice. Ideally, the preoperative visit follows the four key habits of highly effective clinicians, i.e., to rapidly establish a rapport with the patient and provide an agenda for the visit, to explore the patient's perspectives and expectations, to demonstrate empathy, and to focus on the end of the visit with providing information and including the patient in the decision-making process. Visits are then concluded upon obtaining informed consent from the patient.