Zusammenfassung
In der Intensivmedizin nimmt die Invasivität der Interventionen, Komplexität der Krankheitsbilder und das Alter der Patienten ständig zu. Besonders am Lebensende eines kritisch Kranken muss sich die Intensivmedizin ethisch und juristisch brisanten Themen stellen. Im Grenzbereich zwischen Intensiv- und Palliativmedizin begegnen wir zunehmend Patienten mit vital bedrohlicher Atmungsinsuffizienz. Moderne Beatmungsverfahren bieten die Chance, die insuffiziente Atmung und damit Lebensqualität zu verbessern. Diese Behandlungsformen bergen aber die Gefahr, ein würdevolles Sterben am Ende einer langen Krankengeschichte zu verhindern und damit das Leiden des Patienten unnötig zu verlängern. Im Gegensatz zur Intubation mit invasiver Beatmung erlaubt es die nicht-invasive Beatmung dem Patienten, an den Entscheidungsprozessen aktiv teilnehmen zu können. Auch wenn der Patient als autonomes Wesen prinzipiell die Entscheidung für oder gegen eine Behandlung selber trifft, ist dies in der Intensivmedizin aus unterschiedlichen Gründen selten zu realisieren. Der chronisch kranke Patient hat jedoch die Möglichkeit, durch frühe Aufklärung und gemeinsame Entscheidungsfindung mit dem Arzt seinen Willen bzgl. der intensivmedizinischen Therapieform der führenden Organerkrankung, wie z. B. Beatmung, zu formulieren. Unter besonderer Berücksichtigung ethischer und juristischer Aspekte des Lebensendes behandelt dieser Artikel die Möglichkeiten der Beatmung, aber auch deren Begrenzung und Abbruch.
Abstract
Invasiveness of interventions, complexity of diseases and patients' age are increasing in intensive care medicine. Ethical and legal issues are particularly challenging at the end of life of critically ill patients. At the borderline between intensive care and palliative medicine a significant amount of patients suffer from respiratory failure. Modern modes of mechanical ventilation may be able to improve ventilation and quality of life. On the other hand they may oppose a dignified death at the end of a long lasting chronic disease and e. g. prolong the suffering. In contrast to endotracheal intubation and invasive mechanical ventilation NIV enables patients to participate in the decision making process. While under normal circumstances, ethical standards dictate that patients themselves participate in the medical decision making process. For several reasons this is not always possible in intensive care medicine. However, chronically ill patients should get information from experts already at an early stage of the disease, go through a shared decision process and declare their will concerning interventions of intensive care medicine, e. g. mechanical ventilation. With respect to ethical and legal aspects of end of life this paper deals with chances of mechanical ventilation, including its withdrawal and withholding.
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Prof. Dr. med. Bernd Schönhofer
Abteilung für Pneumologie und internistische Intensivmedizin · Klinikum Region Hannover · Krankenhaus Oststadt - Heidehaus
Podbielskistraße 380
30659 Hannover
eMail: Bernd.Schoenhofer@t-online.de
