Featured Research

from universities, journals, and other organizations

How German palliative care physicians act at the end of life

Date:
September 7, 2010
Source:
SAGE Publications UK
Summary:
Discussions about end-of-life practices in Germany have been almost taboo for over half a century, but now intense debate is underway as professional bodies review their guidelines to physicians caring for the dying. A new study reveals that German physicians do hasten death in some cases, against current ethical guidelines -- sometimes without sufficient patient involvement.

Discussions about end of life practices in Germany have been almost taboo for over half a century, but now intense debate is underway as professional bodies review their guidelines to physicians caring for the dying. A new study published in Palliative Medicine, published by SAGE, reveals that German physicians do hasten death in some cases, against current ethical guidelines -- sometimes without sufficient patient involvement.

Related Articles


In light of the recent publication of a survey on German physicians attitudes towards end of life practices which had been issued by the German Medical Association and the current review of professional guidance on physicians' care at the end of life, this new study on physicians' practices at the end of life based on a postal survey of physician members of the German Society for Palliative Medicine could not be more timely.

Three colleagues at the Institute for Medical Ethics and History of Medicine at Ruhr-University, Bochum -- Jochen Vollmann, Jan Schildmann and Julia Hoetzel, together with Christof Mueller-Busch, president of the German Society for Palliative Medicine, sent questionnaires to society members, and more than half responded, yielding 780 eligible questionnaires for analysis. Questions focused on treatment of the last patient under each physician's care to have died, based on a questionnaire developed by the EURELD (European end of life decision) consortium, previously used in seven other European countries.

The researchers found that physicians alleviated symptoms in 78 percent of patients and limited medical treatment with possible life shortening effects in 69 percent of cases. In 10 cases medication had been administered by the physician (9) or the patient (1) to deliberately hasten death. Those physicians with extra qualifications in palliative care were less likely to report deliberate actions to hasten death.

Competent patients were not always involved in these decisions: in 353 cases physicians described their respective patients as capable to make a decision, yet 47 of these patients were denied the opportunity to take those decisions for themselves. Physicians' explanations cited the patients' best interest, and avoidance of possible harm to the patient, all of which suggest a paternalistic approach to care.

"The findings on patients' non-involvement in decision making warrant further empirical and ethical analysis," says corresponding author, Jan Schildmann. In Germany, the Federal Court of Justice (Bundesgerichtshof) states that while limiting medical treatment and alleviating symptoms with possible life shortening consequences is lawful if it is the patient's will, it is illegal for physicians to administer substances which cause death even if the patient wants them to. Likewise the German Society for Palliative Medicine takes a clear stance against hastening death in its statutes. German Medical Association guidance outlaws assisted suicide as unethical.

"It is a remarkable finding that a relevant proportion of respondents -- and even more those who have not acquired the added certificate of qualification in palliative medicine -- not only foresees but also intends shortening of life as part of their practice," says Schildmann.

Although the norms of official organisations oppose assisted death, earlier surveys have suggested that a small cadre of German Society for Palliative Medicine members support it. "The gap between official norms and physicians' moral beliefs may be the starting point for an honest debate within the medical community. The data should contribute to develop an appropriate normative and practical framework for physicians working with patients near death" says Prof. Vollmann.

Unlike many other countries, very little robust data on end of life practices among physicians in Germany exists. Ethical and clinical aspects of end of life practices have been a taboo subject in Germany, in the aftermath of patient murders witnessed under the Nazi regime.

The authors caution that while physician members of the German Society for Palliative Medicine are a relevant and interesting group to investigate, the sample is not necessarily representative for all physicians working in Germany. The authors hope that their findings will contribute to the present debate on assisted death in Germany.


Story Source:

The above story is based on materials provided by SAGE Publications UK. Note: Materials may be edited for content and length.


Journal Reference:

  1. J. Schildmann, J. Hoetzel, C. Mueller-Busch, J. Vollmann. End-of-life practices in palliative care: a cross sectional survey of physician members of the German Society for Palliative Medicine. Palliative Medicine, 2010; DOI: 10.1177/0269216310381663

Cite This Page:

SAGE Publications UK. "How German palliative care physicians act at the end of life." ScienceDaily. ScienceDaily, 7 September 2010. <www.sciencedaily.com/releases/2010/09/100907104033.htm>.
SAGE Publications UK. (2010, September 7). How German palliative care physicians act at the end of life. ScienceDaily. Retrieved December 20, 2014 from www.sciencedaily.com/releases/2010/09/100907104033.htm
SAGE Publications UK. "How German palliative care physicians act at the end of life." ScienceDaily. www.sciencedaily.com/releases/2010/09/100907104033.htm (accessed December 20, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Saturday, December 20, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

The Best Tips to Curb Holiday Carbs

The Best Tips to Curb Holiday Carbs

Buzz60 (Dec. 19, 2014) It's hard to resist those delicious but fattening carbs we all crave during the winter months, but there are some ways to stay satisfied without consuming the extra calories. Vanessa Freeman (@VanessaFreeTV) has the details. Video provided by Buzz60
Powered by NewsLook.com
Sierra Leone Bikers Spread the Message to Fight Ebola

Sierra Leone Bikers Spread the Message to Fight Ebola

AFP (Dec. 19, 2014) More than 100 motorcyclists hit the road to spread awareness messages about Ebola. Nearly 7,000 people have now died from the virus, almost all of them in west Africa, according to the World Health Organization. Video provided by AFP
Powered by NewsLook.com
Researchers Test Colombian Village With High Alzheimer's Rates

Researchers Test Colombian Village With High Alzheimer's Rates

AFP (Dec. 19, 2014) In Yarumal, a village in N. Colombia, Alzheimer's has ravaged a disproportionately large number of families. A genetic "curse" that may pave the way for research on how to treat the disease that claims a new victim every four seconds. Duration: 02:42 Video provided by AFP
Powered by NewsLook.com
The Best Protein-Filled Foods to Energize You for the New Year

The Best Protein-Filled Foods to Energize You for the New Year

Buzz60 (Dec. 19, 2014) The new year is coming and nothing will energize you more for 2015 than protein-filled foods. Fitness and nutrition expert John Basedow (@JohnBasedow) gives his favorite high protein foods that will help you build muscle, lose fat and have endless energy. Video provided by Buzz60
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins