Citation

Konietzko N. Pneumologe 2012; 9(5): 359-369.

Copyright

(Copyright © 2012)

DOI

10.1007/s10405-011-0523-5

PMID

unavailable

Abstract

Chronic diseases increase with age so that progressive chronic pulmonary disease and multimorbidity become more and more complex until the limits of therapeutic options are reached. For the pulmonary diseases COPD, lung cancer and pneumonia, these limits are the subject of guidelines but implementation requires the knowledge and skills of physicians and decisions should be based on sound ethical grounds. Present western understanding of medical ethics is derived from Plato's theory of virtue, the Christian order of charity and patient autonomy in terms of informed consent. The ethical principles follow a hierarchical order in that patient autonomy has priority over the medical principles of care, do not harm and justice. While euthanasia and assisted suicide are still a matter of controversial public debate, advanced healthcare directives and proxy have recently been regulated by law in Germany and are now common practice. Palliative medicine and hospice are helpful for patients at the end of life and for physicians to fulfill their duty to help the patient die in dignity. Ethical questions are not only important in the context of individual physician-patient relationships but also of increasing significance for the medical society as a whole in the face of the permanent crisis in the health system. The influence of economics on medicine, the increasing age of the population and its consequences on the health system, limited resources, priorities and distributive justice have to be addressed by the medical society before politicians set directives. In answering these important questions physicians must be orientated in the first line to the welfare of the patient. © Springer-Verlag 2012.

Language: de

Keywords

human; Germany; assisted suicide; Euthanasia; medical ethics; Aging; article; euthanasia; geriatric care; informed consent; medical decision making; practice guideline; palliative therapy; medical society; health care; chronic obstructive lung disease; justice; social welfare; hospice care; Medical ethics; patient autonomy; Palliative medicine; Chronic obstructive lung disease; Ethical codes