Ethikberatung in der ambulanten Versorgung

Abstract

BACKROUND: Clinical ethics consultation is proven and established in Germany and many other countries. Trained consultants support hospital-doctors in finding solutions for ethical conflicts occuring in the hospital. Ethics consultations in the ambulant care are rare, although general practitioners (GPs) are confronted with difficult situations in the ambulant setting as well. AIM: This study explores the GPs’ perspectives on the frequency of ethical conflicts and their requirement of ambulant ethics consultation. METHOD: A questionnaire was sent to 1000 GPs with questions about conflicts in ambulant care and need of ethical/s consultation in ambulant setting. RESULT: 45,6% of the GPs answered the questionnaire. Three conflicts are experienced approximately once a month: Continuation of a potentially curative therapy which is tolerated badly by the patient; discontinuation of medication with doubtful use for the patient; sense of diagnostic steps for seriously ill patients. Two thirds of the GPs took part in quality circles, more than 50% found support. One third wished for ambulant ethics consultation, of which more women than men formulated this wish, another third did not wish for ambulant ethic consultation. GPs wanted to reach the consultants by phone (81,5%), they were also interested in retrospective case discussion (55,6%). Consultants should be general practitioners (60,1%) or doctors in general (55,7%). They should have knowledge about medicine (89%) and medical law (86,5%) and experience in ambulant patient care (89,5%). A payment for using ethic consultation was relevant for 25% of the GPs. CONCLUSION: Ethical conflicts in GP practice occur frequently, possibilities for support are rare. An ambulant ethics consultation would presentsa promising option for most of the GPs, especially for female GPs. Ambulant ethics consultation could therefore generally help GPs to deal with difficult ethical situations.