Wenn der Sterbeprozess nicht zum Tod führt

Abstract

For some patients death no longer occurs as an event but comes at the end of a prolonged dying process. Particularly in patients with primary or secondary brain injury, physiological body functions can be maintained for weeks and months thanks to modern medical technology but these patients will never have a chance to regain consciousness. How long this dying process lasts depends on the intensity and duration of the medical and technical measures. It is known that the attitude of the population in Germany is divided with respect to the question of intensive medical measures to preserve life. According to a survey carried out by the Social Scientific Institute of The Evangelical Church in Germany (EKD), 57% of the participants feared being kept alive only by “machines”, whereas 30% were worried that the medical measures will not be exhausted and death prematurely occurs [1]. As far as an advance directive (living will) is present or a clearly expressed will can be identified, the legal and medical situations are unambiguous. The physician must respect and follow the self-determined will of the patient, the patient’s will is binding; however, there is a much more difficult problem if this will is not known or not clearly expressed. This problem area results in highly complex ethical, legal and social crossroads issues: is the limitation of medical and technical measures permitted under certain circumstances? Which criteria should be used as a basis for such a decision? Who has the authority to make the decision? Do we need a consensus procedure that leads to the decision? This article addresses these questions and aims to intensify the discussion on a problem that will become significantly more important in the future due to the rapid progress in medicine.