Sterbebegleitung oder Sterbehilfe als Ärztlicher Auftrag
Terminal Care or Medical Aided Suicide as Medical Duties? Ethical Problems Concerning the End of Life

Summary/Abstract: The medical disciplines haematology and oncology as parts of Internal Medicine include the palliative care of critically ill and sometimes moribund patients. This often implies making decisions at the end of life, that open up numerous ethical questions and conflicts, which have now increasingly become subject to a public debate. In this regard, palliative care of dying patients and the different possible ways of medically aided suicide have gained widespread attention. Thus, the increasing self-government of patients has changed the typical physician-patient relationships and traditional paternalistic interactions. The justification of actively aided suicide in moribund patients not only raises legal issues, but also various questions around the patients’ self-determination on the one hand and responsible medical care on the other hand. The call for legalizing medically aided suicide for patients, who explicitly opt for a shortening of the intolerable process of dying, is opposed by social concerns about the relativization of the culturally inherited ban of willful homicide. Both opponents and supporters of this concept are arguing about their interpretation of terms like personality, autonomy and pride. In this context, socio-cultural as well as individual perceptions of traded values in the sense of an anthropological interpretation play an important role. It remains to be demonstrated that patient-oriented medical care is able to maintain the individual patient’s pride and self-determination, even under conditions of an increasing institutionalization of the dying process as a consequence of demographic changes. On that background, the desire for premature termination of life on a voluntary or non-voluntary basis through medical intervention appears rather dispensable. Such argumentation should resist the concerns raised by consequentialistic and utilitarian ethics, provided that the reliance between physician and patient proves as a discourse between morally-driven persons that extends beyond formal contracts. Medical ethics based on normative reasoning and deontological perspectives are essential premises to achieve these goals.

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