Michael Welker | Eva Winkler | John Witte, Jr. | Stephen Pickard (Eds.): The Impact of Health Care (Leseprobe)

48 Christine Thomas
ate adjustments to the medical infrastructure (for example, adapting hospital
structurestothe needs of the elderly and cognitively impaired), and the attitude
of society as awhole of apostulated loss of quality of life in the case of physical
and cognitive impairments—all of these factors promote the overvaluation of a
pseudo-autonomous (because ultimately fear-driven) decision to aself-determined
end of life, which is then classified as “more dignified.” Regulatory failures
to provide adapted living space and to take over care for those in need at the
borders of society (addicts, the homeless, those who are difficult to integrate socially,
and people who do not seek help, for instance) must be corrected.
In addition, the deficits inhospital financing, especially in medical care for
the old and the oldest-old stand in stark contrast to medical advances in diagnostics
and therapy, the general increase in costs, and the growing, unrealistic
expectations of relatives and patients, which are partly influenced by society,
the media, and evenhealth-insurance funds. Hospital costs represent the largest
area of expenditure for health-insurance funds. The claim to “sufficient, appropriate,
but not exceeding the necessary quality of treatment” 1 anchored in the
social laws of Germany is not communicated in this way to the individual healthinsurance
policyholder,who expects high-quality, patient-centered care with the
best possible end result. This performance requirement also contrasts with the
orientation toward patient welfare as an ethical standard called for bythe German
Ethics Council in its statement of April 2016. 2 This discrepancy between
the reality of the profession and the professional ethos ultimately leads to the
exploitation ofthe good will and ideals of medical and nursing staff and to their
frequently leaving the profession—or leaving it emotionally and mentally, and
thus turning away from their vocation.
In contrast, society should rather be confronted with the demand to provide
humane companionship and professional care until death and to provide education
about the possibilities of pain- and suffering-free abstention from food and
fluids at the end of life. Particularly inthe case of dementia, which is ultimately
fatal, it is especially important to use quality of life as aguideline in order not to
either underprovide or overprovide care, not to inappropriately limit autonomy
or inappropriately reject care. At the same time, however, the demand on society
and the individual must be formulated to do justice to this ethical responsibility,
to distribute resources fairly and honor the willingness to finance the security
systems as acommunity of solidarity, to ward off abuse, and to anchor both care
and security in law.
In addition, areturn to the principle of no harm, or nil nocere, must be demanded
in medical practice. This professional orientation toward evidence-
1
2
Social Code (SGB) Book Five (V)—Statutory Health Insurance, Section 39.
The German Ethics Council: “The Well-Being of Patients as an Ethical Benchmark for
Hospitals.” Official Statement. German Ethics Council, Berlin, 2016.