Abstrakt

Modern critical care enables the treatment of seriously or chronically ill or injured patients – even in old age and over long periods of time. However, after prolonged intensive care and, if necessary, rehabilitation therapy, many patients develop post-intensive care syndrome (PICS) which severely affects their quality of life and that of their families. The legitimacy of critical care is based on the “two-pillar model”, medical indication and informed consent of the patient. In addition, determining a therapeutic goal that reconciles sensible medical options with the wishes and values of the patient is indispensable (as far as possible under the given circumstances). Therapeutic goals are to be understood as a dynamic continuum; though, they can and occasionally must change in the course of time. With regards to ethical decision-making, the prognostic uncertainty and the multifactorial implementation of measures that are not or no longer indicated are the central challenges. Ethically appropriate decisions require a realistic assessment of the respective medical options, a regular re-evaluation of the therapeutic goal, adequate team communication, and regularly conducted family meetings. The quality of the working climate correlates with timely end-of-life decisions and prevents moral distress. If life-sustaining measures cannot or no longer help to achieve the (previous) therapeutic goal, a change of the therapeutic goal to end-of-life care is necessary.

Autoreninformation

Autoren

• A. Michalsen¹
• U. Janssens²

Abteilungen

• ¹ Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Konstanz, Konstanz,
• ² Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital Eschweiler, Eschweiler

Adresse

Dr. med. Andrej Michalsen, M.P.H./Univ. of Texas
Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie
Klinikum Konstanz
Mainaustr. 35
78464 Konstanz
Email: [email protected]

Citation