STERBEBEGLEITUNG ODER STERBEHILFE ALS ÄRZTLICHER AUFTRAG

Abstract

The medical disciplines haematology and oncology as parts of Internal Medicineinclude the palliative care of critically ill and sometimes moribund patients. This often impliesmaking decisions at the end of life, that open up numerous ethical questions and confl icts, whichhave now increasingly become subject to a public debate. In this regard, palliative care of dyingpatients and the different possible ways of medically aided suicide have gained widespread attention.Thus, the increasing self-government of patients has changed the typical physician-patientrelationships and traditional paternalistic interactions. The justifi cation of actively aided suicidein moribund patients not only raises legal issues, but also various questions around the patients’self-determination on the one hand and responsible medical care on the other hand. The call forlegalizing medically aided suicide for patients, who explicitly opt for a shortening of the intolerableprocess of dying, is opposed by social concerns about the relativization of the culturally inheritedban of wilful homicide. Both opponents and supporters of this concept are arguing abouttheir interpretation of terms like personality, autonomy and pride. In this context, socio-culturalas well as individual perceptions of traded values in the sense of an anthropological interpretationplay an important role. It remains to be demonstrated that patient-oriented medical care isable to maintain the individual patient’s pride and self-determination, even under conditions ofan increasing institutionalization of the dying process as a consequence of demographic changes.On that background, the desire for premature termination of life on a voluntary or non-voluntarybasis through medical intervention appears rather dispensable. Such argumentation should resistthe concerns raised by consequentialistic and utilitarian ethics, provided that the reliance betweenphysician and patient proves as a discourse between morally-driven persons that extends beyondformal contracts. Medical ethics based on normative reasoning and deontological perspectivesare essential premises to achieve these goals.