Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Aug 2002
[Providing or withholding treatment: the role of the patient's wish and priorities in palliative care].
Medical law and ethics require that intervention be based on patients' wishes. However, in particular the presumed wish of the patient, is often difficult to establish. Discussions with patients may want to inform or influence the patient's wishes. We investigated how far clinical decisions recognize the patient's wishes and how the presumed wishes of the patient is established and respected. ⋯ Patients will plays a prominent role in treatment decisions; Even more so, physicians follow patients' wishes when withholding or withdrawing treatment. Our study could not find out how widely information of the patient plays a role in altering the patient's wishes in a paternalistic manner. Given a relative unfamiliarity with advance directives, affirmative attitudes towards their recognition are remarkable. As far as palliative and comfort care for terminal patients is concerned, contrary to widely voiced concern, clinicians do not have priorities different from those used in hospice care.
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Dtsch. Med. Wochenschr. · Aug 2002
[Treatment regulations and treatment limits: factors influencing clinical decision-making].
Providing or withholding of treatment is based on a variety of factors. We sought for criteria in clinical decision making and reviewed attitudes towards clinical intuition and the patient's will. ⋯ A patient's will plays a prominent role in clinical decision making, especially in decisions to withdraw or to withhold treatment. Cost containment and research interest have been called less important, a remarkable response from research-based university hospitals. Also remarkable is the recognition and importance of clinical intuition in situations of complex or missing information. This important aspect is rarely discussed in the literature or in medical education. The widely voiced concern that priorities in clinical care are guided by scientific interest, financial or technical possibilities could not be confirmed.