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The German Society for the Study of Pain has formed an interdisciplinary committee to answer urgent ethical questions on the diagnosis and treatment of pain and to give an ethical orientation on the care of pain and palliative patients. The treatment of pain is a fundamental objective of medicine. Competent and adequate relief of pain in all stages of life is a basic characteristic of a humane medicine oriented to the quality and meaning of life for people. However, there are substantial deficits in all areas, especially in the knowledge of physicians and patients, in training and further education, diagnosis and therapy. Freedom from pain is a substantial element of quality of life. A central duty of all physicians is an adequate diagnosis and treatment of acute pain and thereby the prophylaxis of chronic pain. If pain persists over a longer period of time, it loses the warning function and becomes taken for granted. Alterations, disabilities and limitations of the physical, psychic and social levels are the consequences. For these patients an interdisciplinary approach is necessary by which various medical disciplines, psychologists and physiotherapists are involved and all collaborate on the diagnosis and therapy of pain. All patients have the right to sufficient and individually tailored treatment of pain. Special attention must be paid to vulnerable patient groups, such as newborns, children and adolescents, as well as aged and mentally retarded patients. For cancer patients pain relief of their tumor pain is totally in the forefront. Indications of "unbearable pain" must not lead to resignation or even be seen as an argument for legalization of "death on request". The nursing of terminally ill patients necessitates a special measure not only of clinical, but also ethical competence, communication and multiprofessional collaboration. The modern options for palliative care are real alternatives to demands for legalization of "death on request". Physician-assisted suicide does not belong to the scope of functions of palliative medicine. The basic constitutional law makes an appropriate treatment of pain obligatory. Neglect of pain treatment fulfils the elements of criminal bodily harm. As a consequence, there is a legal right to a comprehensive pain diagnosis and a pain treatment corresponding to the appropriate standard. The state is obliged to provide the legal, social and financial prerequisites for an adequate treatment of pain. Continuous efforts in research are necessary to fill the existing gaps in our knowledge. The transfer between basic research and clinical application of pain therapy must be urgently improved. Of central importance for the German Pain Society are therefore: Improvement of training and further education in pain therapy. Chronic pain must be accepted and coded as an autonomous sickness. Graded structures for care of pain patients must be realized. Interdisciplinary structures of care must be made available to patients with chronic pain. Palliative medical care is a basic right of all...

In the Federal Republic of Germany the medical and therapeutic methods available for combatting the most severely painful states are not always fully exploited. The medical legislation currently being developed gradually gives the treatment of pain the importance it deserves according to patients' needs. The legal position to be borne in mind in pain therapy is presented.

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Inwieweit ärzte zur Lebenserhaltung verpflichtet sind, ergibt sich mittelbar aus dem Dritten Gesetz zur ände-rung des Betreuungsrechts vom 29. 7. 2009, das die Bindungskraft von Patientenverfügungen festlegt. Außerdem lassen sich diesem Gesetz wichtige entscheidungsgrundlagen für lebenserhaltende Maßnahmen auch für den fall entnehmen, dass keine Patientenverfügung vorliegt oder die festlegungen einer Patientenverfügung nicht auf die aktuelle Lebens-und Behandlungssituation zutreffen. Dies sind u. a. die ärztliche Indikation, Behandlungswün-sche oder der mutmaßliche Wille des entscheidungsunf ä-higen Patienten sowie die Notwendigkeit, einwilligungen oder Nichteinwilligungen des Betreuers oder Bevollmächtigten in schwerwiegende ärztliche Maßnah-men gerichtlich genehmigen zu lassen, soweit Patientenvertreter und Arzt den Patientenwillen unterschiedlich auslegen. Hierdurch wird die rechtliche Verantwortlichkeit des Arztes gestärkt.