Ethics in Family Medicine: „Who am I to Make such a Decision“
DOI: 10.3238/zfa.2017.0319-0323german translation / full article
Summary: An ongoing qualitative study at the Charité Berlin is examining the experience of family physicians with moral conflicts and the potential need for ethical advice. We analyze a case report from this interview study by using a principle-oriented approach. During an out-of-hours service, a family physician is being called to see an 85 years old, previously unknown patient in a nursing home, who is suffering from angina. On arrival, the patient apparently has just passed away. The family physician is confronted with the decision whether or not to start resuscitation. No details about the patient are known. The nurse does not know whether an advance decision has been laid down. The family physician decides against resuscitation, but is unsure about this choice when reflecting on the case afterwards.
We identify criteria for a retrospective ethical reflection of the case. The assessment of the medical indication and of the patient‘s will seems crucial. However, without any knowledge of the patient‘s preferences this proves to be insufficient. The recommendation of resuscitation guidelines to always begin with resuscitation if in doubt seems hard to follow without a clear idea of any goal of therapy that is realistically attainable. The application of the ethical principles in health care, as formulated by Beauchamp und Childress (respect for autonomy, nonmaleficence, beneficence, and justice), can help to reach a responsible decision in the best interest of the patient.