Suchergebnisse

Deckblatt -- Titel -- Impressum -- Inhalt -- Autoren -- Vorworte -- Vorwort zur 1. Auflage -- Vorwort zur 2. Auflage -- 1 Einleitung -- 1.1 Problem -- 1.1.1 Rahmenbedingungen für medizinische Entscheidungen am Lebensende -- 1.1.2 Praxis und Regelung der Suizidhilfe in Deutschland -- 1.1.3 Urteil des Bundesverfassungsgerichts und gesetzlicher Regelungsbedarf -- 1.2 Ziele dieses Gesetzesvorschlags -- 2 Gesetzesvorschlag -- 3 Begründung -- 3.1 Ausgangslage -- 3.1.1 Gesellschaftlicher Hintergrund -- 3.1.2 Aktuelle Rechtslage -- 3.1.3 Regelungen in anderen Ländern -- 3.2 Die Lösung des Gesetzesvorschlags -- 3.2.1 Medizinische Aspekte -- 3.2.2 Gesellschaftliche Aspekte -- 3.2.3 Ethische Grundlagen dieses Gesetzesvorschlags -- 3.3 Begründung des Gesetzesvorschlags im Detail -- Zu Artikel 1 (Änderungen des Strafgesetzbuchs) -- Zu Artikel 2 (Änderungen des Betäubungsmittelgesetzes) -- Zu Artikel 3 (Inkrafttreten) -- 3.4 Begleitende Maßnahmen -- 3.4.1 Dokumentation und wissenschaftliche Begleitforschung -- 3.4.2 Palliativmedizin, Suizidprävention, Übertherapie und soziale Maßnahmen -- 4 Schlussbemerkung -- Literatur -- Gesetz zur Regelung des assistierten Suizids.

"Background: Worldwide, assisted dying is currently on the rise. For health care professionals (HCP), this raises questions regarding roles and responsibilities. Switzerland is a social laboratory for a non-medicalized form of suicide assistance (SA). Aims: To describe experiences and attitudes of Swiss HCP toward SA in the hospital setting and to identify associated factors. Methods: An online questionnaire survey targeted all HCP involved in patient care at two tertiary hospitals in French-speaking Switzerland. The primary outcome was a favorable attitude toward SA. Associated factors were assessed using logistic regression. Results: A total of 5127 professionals responded (37.1%). The sample was representative of the hospitals, with 74% being female, 52% nurses, 23% physicians and 25% other professions. 69% supported the view that each HCP should have the choice to participate or not in SA. The majority favored access to SA in case of severe somatic illnesses, irrespective of prognosis, but less for patients with mental disorders or healthy seniors. 60% of all HCP were generally ready to be involved in SA, but only 30% of physicians would prescribe a lethal substance. 58% of HCP would consider assisted suicide for themselves in certain circumstances. Independent factors associated with a favorable attitude toward SA were: younger age, graduation in Switzerland, non-physician profession. Working in palliative care or being protestant was associated with a less favorable attitude. Conclusion: The diverse attitudes of HCP suggest that the Swiss model of SA may have to be reconsidered, including the question about the participation of hospital workers. "

Das Buch dokumentiert die Beiträge des internationalen Symposiums "Assistierter Suizid: Der Stand der Wissenschaft" vom 15. Juni 2015 in Berlin. Es bietet einen einmaligen Überblick über die aktuellen empirischen Untersuchungen zum Thema, die in der politischen Debatte teilweise schlicht ignoriert wurden und immer noch ignoriert werden. Es enthält außerdem die Transkripte aufschlussreicher Pro-Contra Debatten zwischen Vertretern unterschiedlicher Positionen aus den Fachgebieten Recht, Medizin und Ethik. Am Schluss steht eine ausführliche Kommentierung des neuen Gesetzes "zur Strafbarkeit der geschäftsmäßigen Förderung der Selbsttötung" aus rechtlicher, medizinischer und ethischer Perspektive. Die Autoren und Herausgeber sind international ausgewiesene Experten aus Deutschland und aus anderen Staaten, in denen die Tötung auf Verlangen und/oder der assistierte Suizid gesetzlich geregelt sind (Niederlande, Schweiz, USA)

"Health decisions occur in a rich context in which social influences are omnipresent. The tendency to compare oneself with others has been described as one of the critical social factors influencing decision making. Based on a collection of 43 audio-recordings of hospital admission encounters which were analyzed though a conversation analytic methodology, we present findings and reflections in regard to how patients and physicians discuss cardio-pulmonary resuscitation. The phenomena of interest concerns how and when patients and physicians refer to what other people decide (for example: "Often the patients tell us: No futile care"). This practice is encountered in 6 of the conversations recorded. Reference to other people's decisions is a way to talk about options, but it does much more than just enumerating them. As a resource in interaction, this reference is employed when the patient can't or doesn't express a preference (thereby clarifying options) or when the preference the patient expressed is problematic (because contrary to expectations). By using this reference, decision making is projected as a matter of membership to a group of individuals, and not as a matter of individual prognostic.The ethical implications of referring to other people's choices are significant, since it can influence the patient and pose a serious threat to autonomous decisions. We argue that findings such as ours, stemming from data-driven studies of healthcare communication, are pivotal for informing ethics education in its effort to address the biases that physicians impose upon patients during decision making. "

Die moderne Biomedizin birgt zahlreiche moralische Herausforderungen und Dilemmata, die in pluralen Gesellschaften nicht immer einvernehmlich gelöst werden können. Dennoch müssen auf individueller, institutioneller und gesellschaftlicher Ebene Entscheidungen getroffen und Regelungen gefunden werden. Hierbei sind verschiedene, häufig miteinander in Konflikt stehende ethische Normen, Werte, Ideale und Interessen zu berücksichtigen. Wie in solchen Spannungsfeldern angemessene Entscheidungen gefunden werden können, ist bisher weder in der Praxis noch in der Theorie ausreichend geklärt. Dieser Band versammelt Beiträge verschiedener Disziplinen zu der Frage, wie ethische Entscheidungen in der Medizin und im Gesundheitswesen in einer gut begründeten Art und Weise getroffen werden können. Sie schlagen eine Brücke zwischen ethischer Theoriebildung und konkreter Entscheidungsfindung in der Praxis. Neben Beiträgen zu philosophischen Grundlagen ethischer Entscheidungen und zur Anwendung verschiedener Ethiktheorien auf einen klinischen Einzelfall werden Beiträge zu relevanten Entscheidungskontexten und -instrumenten der klinischen Praxis sowie der biomedizinischen Forschung und Politik geleistet

"Advance care planning (ACP) has become widely used in medical care in order to plan ahead of a loss of decision-making capacity. Since ACP aim is to promote anticipatory and substitute autonomy by engaging people ‒ and possibly their relatives ‒ in deciding about future goals of care and treatments, scientific literature in this field often posits that ACP involve shared decision-making. This assumption however is rarely backed up by an in-depth reflection on how shared decision-making might operate within ACP and which shared decision-making template is more likely to foster ACP. Our ACP tool, based on a model created at the Zurich University Hospital (Krones et al, 2019), engages patients in a structured communicational process about their values and preferences for care. In this tool, ACP facilitators help patients set goals of care and document treatments decisions in three paradigmatic situations of loss of decision-making capacity. Because our ACP tool entails discussions about goals of care, quality of life, and options in terms of disease- or symptom-management, we turned to Elwyn and al.'s three talk's model (2012) and Vermunt et al.'s three level goal model (2018) in order to incorporate elements of shared decision-making in our ACP tool. In this presentation we discuss how these models might be combined in order to foster shared decision-making within our ACP tool and, by then, broaden its scope and eventually improve its effectiveness, strengthen its theoretical foundations and uphold the ethics of care in the event of a loss of decision-making capacity. "