Vorsorgedokumente in der präklinischen Notfallmedizin

Abstract

The results show that for an AD to apply in an emergency situation certain standards are necessary that assure the practicability, especially if a patient does not wish to be resuscitated. Most difficulties with ADs occurred with imprecise formulation, text length and inconsistency of statements. The following instructions were usually missing: hierarchy of those given power of attorney and specification on medication, information about the scope of the ADs, statement about resuscitation, extent and limitations of the desired treatment, especially with patients certified as terminally ill and instructions on who should decide about medical treatment in a conflict situation. A so-called emergency instruction which gives on a single page the patient's statement on resuscitation would have been very helpful in individual cases. The results suggest that patients may need more information and education about AD to guarantee patients rights and self-determination.

Intricate decision making: ambivalences and barriers when fulfilling an advance directive

“…It explains the discrepancy observed to date in Germany and the US, for example, between the significance attached to the mechanism of an AD in public surveys and its rather limited distribution 5,7,8,10,11. The spread of ADs in the sample surveyed in this study corresponds with that in other investigations 2,3,6,10. The majority of the sample know about the mechanism of ADs (data not shown in this article).…”

“…Even after the passage of the act, the spread of advance directives (ADs) has remained limited 1–6. Even in selected groups, it reaches a maximum of 23%–31% 1,4,6.…”

“…Even after the passage of the act, the spread of advance directives (ADs) has remained limited 1–6. Even in selected groups, it reaches a maximum of 23%–31% 1,4,6. This is in contrast to the positive attitude of a majority of patients and healthy people, who consider the drafting of an AD for themselves as meaningful and important 7,8.…”

“…People show considerable insecurity in making decisions for treatment situations that lie in the future 6,16. Ambivalent attitudes toward life-sustaining therapies in critical phases of an illness, or close to the end of a person’s life, appear to be more the rule than the exception.…”

“…Studies of the barriers that interfere with the practical implementation of what had been laid down in ADs are mainly to deal with the problems of application of ADs, such as the inconsistency of their contents, or the availability of the documents at the time of making a decision, and so forth 6,11,13,20,21. Whether subjective fears are obstructive, and whether people ever consider themselves to be able to make life-changing decisions about the terms of treatment in advance, has not been sufficiently investigated to date, and where investigated it was done only in small samples of the population 22…”