ZusammenfassungIn der aktuellen ethischen Debatte über die ärztliche Unterstützung bei der Selbsttötung von schwerkranken Patienten werden von unterschiedlicher Seite strafrechtliche Verbote gefordert. Ging es zunächst in der politischen Debatte ausschließlich um das Verbot organisierter Formen der Beihilfe zur Selbsttötung, werden nunmehr einerseits auch weitergehende strafrechtliche Verbote bis hin zum Verbot jeder Form von Beihilfehandlungen wie andererseits die ausdrückliche Zulassung der Suizidbeihilfe durch Ärzte gefordert. Ausgehend vom Ansatz, ein Verbot der Suizidassistenz im Strafgesetzbuch aufzunehmen, zeigt der Artikel, dass die Straflosigkeit von (...) Suizid und Suizidassistenz in Deutschland auf eine lange Tradition zurückgeht. Die Straflosigkeit der Beihilfe zum Suizid lässt sich dabei nicht nur systematisch, sondern auch inhaltlich begründen. Eine Strafbarkeit hingegen wäre weder rechtlich noch ethisch überzeugend darzustellen. Die Verfasser sprechen sich unter Bezugnahme auf einzelne Regelungsvorschläge gegen ein Strafverbot und schließlich für einen offenen Diskurs innerhalb der Ärzteschaft sowie für eine Neuregelung im Berufsrecht aus. (shrink)

Background: Cancer patients are at risk of developing blood clots in their veins - venous thromboembolism(VTE) - which often takes the form of a pulmonary embolism or deep vein thrombosis. Therisk increases with advanced disease. Evidence based treatment is low molecular weightheparin (LMWH) by daily subcutaneous injection. The aim of this research is to explore thebarriers for doctors in the UK when diagnosing and treating advanced cancer patients withVTE.MethodQualitative, in-depth interview study with 45 doctors (30 across Yorkshire, England and 15across (...) South Wales). Doctors were from three specialties: oncology, palliative medicine andgeneral practice, with a mixture of senior and junior staff. Framework analysis was used. Results: Doctors opinions as to whether LMWH treatment was ethically appropriate for patients whowere symptomatic from VTE but at end of life existed on a shifting continuum, largelyinfluenced by patient prognosis. A lack of immediate benefit coupled with the discomfort of adaily injection had influenced some doctors not to prescribe LMWH. The point at whichLMWH injections should be stopped in patients at the end of life was ambiguous. Someperceived overcaution in their own and other clinicians treatment of patients. Viewpointswere divergent on whether dying of a PE was considered a "good way to go". Theinterventionalism and ethos of palliative medicine was discussed. Conclusions: Decisions are difficult for doctors to make regarding LMWH treatment for advanced cancerpatients with VTE. Treatment for this patient group is bounded to the doctors own moral andethical frameworks. (shrink)

Background Cancer patients are at risk of developing blood clots in their veins - venous thromboembolism - which often takes the form of a pulmonary embolism or deep vein thrombosis. The risk increases with advanced disease. Evidence based treatment is low molecular weight heparin by daily subcutaneous injection. The aim of this research is to explore the barriers for doctors in the UK when diagnosing and treating advanced cancer patients with VTE. Method Qualitative, in-depth interview study with 45 doctors. Doctors (...) were from three specialties: oncology, palliative medicine and general practice, with a mixture of senior and junior staff. Framework analysis was used. Results Doctors opinions as to whether LMWH treatment was ethically appropriate for patients who were symptomatic from VTE but at end of life existed on a shifting continuum, largely influenced by patient prognosis. A lack of immediate benefit coupled with the discomfort of a daily injection had influenced some doctors not to prescribe LMWH. The point at which LMWH injections should be stopped in patients at the end of life was ambiguous_._ Some perceived ‘overcaution’ in their own and other clinicians’ treatment of patients_._ Viewpoints were divergent on whether dying of a PE was considered a “good way to go”. The interventionalism and ethos of palliative medicine was discussed. Conclusions Decisions are difficult for doctors to make regarding LMWH treatment for advanced cancer patients with VTE. Treatment for this patient group is bounded to the doctors own moral and ethical frameworks. (shrink)