Fallstudie: Antibiotika in der Palliativmedizin
The paper at hand explores medical decision-making in instances where a decision on the continuance or withdrawal of the antibiotic therapy of a palliative patient is required. Representatives of hospices, palliative care institutions and oncologic and geriatric clinics were interviewed on the issue of decisions related to a specific therapy and the decision-making criteria which are to be fulfilled. Important criteria were identified to be the achievable quality of life, the prospect of success and patient wishes. Decisions were most frequently justified on the basis of the necessity of symptom monitoring and the statement that therapy is worthwhile. The most frequent reasons for the rejection of therapy were incorrect indication, malignant underlying disease or statements in advance patient directives which declined invasive, life-prolonging treatments. The “urinary tract infection” and “pneumonia” scenarios highlighted concurrences in the assessments given by representatives of various specialisations. Decision-making was shown to be more difficult in the “sepsis” scenario. The case of a young patient exhibiting acute deterioration in their previously good overall health was described and considered. Short- and long-term prognoses were difficult to establish. Age and family situation had differing impacts on the decision. There were also discrepancies between declarations made in the patient’s advanced directive and the wishes of his wife. The majority of oncologic and geriatric clinics support therapy in such cases. The opinion of representatives of hospices and palliative care institutions was shown to be divided. In the majority of cases, hospices, palliative care institutions and geriatric clinics found justification for the rejection of treatment in the instructions set out by the patient in their advanced directive. Hospices and palliative care institutions rejected treatment in instances where the underlying disease was malignant and the prognosis was poor. On the other hand, geriatric and oncologic clinics were found to opt for therapy on a more regular basis, with the patient’s wish to receive treatment the most common justification. The paper at hand identifies variations in approach from specialisation to specialisation. This indicates that in-depth discussion of related issues and the education of doctors in palliative care are both sensible and necessary where the legal and ethical assessment of therapy decisions is concerned.
info:eu-repo/classification/ddc/610, Antibiotikum, Medizin, Antibiotika, Palliativmedizin, antibiotics, palliative medicine
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