The Facts Are Incomplete

Medical Ethical Knowledge and Moral Attitudes Among Physicians in Bavaria by Jana Wandrowski, Dr. rer. nat. Tibor Schuster, Wolfgang Strube, Prof. Dr. med. Florian Steger in Heft 8/2012

In the article, the example case that was to be assessed, the patient’s advance directive was not fully reported. What is missing is any information on whether, according to the text of the patient’s advance directive, life preserving measures should be suspended in principle as soon as the patient is in a coma—that is, irrespective of whether a chance exists that the patient may wake from the coma—or only if the patient’s coma is irreversible. Furthermore we are not told whether there is a chance, there is no chance, or it is uncertain, that the patient will wake from, his/her coma. This means that the facts were not fully reported and the case could thus not be assessed in a meaningful way.

All texts of patients’ advance directives articulate that life preserving measures should be stopped only if the patient’s condition—of not being able to speak or agree—is “irreversible” or if there is “no hope for improvement.” Since in the case under study, this standard and obvious text passage of the patient’s advance directive was not included, physicians were therefore asked to assess a case that cannot actually occur as presented.

The physicians were then asked to answer the question whether their decision to stop life preserving measures depends on the prognosis. If there is a chance a patient may wake from a coma then of course the patient wants life preserving measures—at least until a prognosis is certain. This question could therefore only be answered by “yes,” which makes it odd it was even asked.

The authors maintain that “personal values, moral positions, and knowledge of medical ethics are extremely important in the joint decision-making process of the patient–doctor interaction.” This is incorrect. The legally competent patient’s own wishes form the prerequisite for the legal implementation of an advance directive. Treatment and feeding are permitted only if the patient consents. If a legally competent patient withholds his/her consent then treatments and feeding equate to unlawful forced treatment and force feeding, because of the lacking consent, which is legally compulsory.

DOI: 10.3238/arztebl.2012.0665b

Dr. jur. Rolf Coeppicus

Oberhausen

Conflict of interest statement
The author declares that no conflict of interest exists.

References

1. Coeppicus R: Patientenverfügung, Vorsorgevollmacht und Sterbehilfe: Rechtssicherheit bei Ausstellung und Umsetzung. Klartext-Verlagsgesellschaft 2009.

2. Coeppicus R: Das Gesetz über Patientenverfügungen und Sterbehilfe: Wann sind die Umsetzung von Patientenverfügungen und eine Sterbehilfe rechtmäßig? ecomed Medizin 2011.

3. Wandrowski J, Schuster T, Strube W, Steger F: Medical ethical knowledge and moral attitudes among physicians in Bavaria. Dtsch Arztebl Int 2012; 109(8): 141–7.