[Ad hoc ethical decision-making in clinical acute and emergency medicine : Position paper of the Ethics Section of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) in collaboration with the Ethics Section of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN)]
- PMID: 34989820
- DOI: 10.1007/s00063-021-00897-y
[Ad hoc ethical decision-making in clinical acute and emergency medicine : Position paper of the Ethics Section of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) in collaboration with the Ethics Section of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN)]
Abstract
Decisions with considerable medical and ethical implications are made in emergency departments every day. Despite time pressure and high workloads, they have to be arrived at in an expert manner in all dimensions. For immediate ethical decisions, structuring the decision-making process in the form of standard procedures can be helpful, provided that they are trained and practiced in an interdisciplinary and interprofessional manner. The support for ad hoc ethical decisions presented here recommends an "ethical team time out" for the evaluation of treatment choices, in a framework where the patient's will and medical indication are examined and completed in a structured manner. Further experts (ideally, an ad hoc clinical ethics consultation) should be consulted if the treatment measure is of questionable medical benefit and/or of questionable patient consent.
In Notaufnahmen sind tagtäglich Entscheidungen mit enormer medizinischer und ethischer Tragweite erforderlich. Diese müssen trotz Zeitdruck und hoher Arbeitsbelastung in allen sie betreffenden Dimensionen fachkundig getroffen werden. Eine Strukturierung anhand standardisierter Vorgehensweisen kann bei der ethischen Ad-hoc-Entscheidungsfindung hilfreich sein, vorausgesetzt, dass sie interdisziplinär und interprofessionell geschult und (vor)gelebt werden. Die vorliegende Ad-hoc-Entscheidungshilfe empfiehlt zur Evaluierung der Therapieentscheidung ein „ethical team time out“, in dessen Rahmen Patientenwille und medizinische Indikation strukturiert überprüft werden. Weitere Expertise (im Idealfall im Sinne einer Ad-hoc-Ethikberatung) sollte hinzugezogen werden, wenn Maßnahmen medizinisch nur fraglich sinnvoll sind und/oder die Zustimmung des Patienten fraglich ist.
Keywords: Emergency room; Guideline; Moral distress; Team; Training.
© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.
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