Treatment request

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A treatment request is a precautionary declaration of will about the type, scope and duration as well as the circumstances of a treatment that does not meet the requirements of an advance directive ( Section 1901a Paragraph 2, Section 1901 Paragraph 3 BGB).

Treatment requests within the meaning of Section 1901 a, Paragraph 2 of the German Civil Code (BGB) can include all statements by a person concerned that contain specifications for a specific life and treatment situation, but have not been drawn up in writing, do not make any anticipatory decisions or were written by a person concerned under age. A living will that does not fit the current living and treatment situation of the person concerned and therefore has no immediate effect can also be considered as a treatment request.

Importance in care law

If the person concerned has expressed their will, it binds the supervisor as an expression of the continued right of self-determination . The patient's will must always be observed, regardless of the form in which it is expressed.

In the case of an effective living will, it is up to the carer to express the will of the person concerned to the attending physician and enforce it ( Section 1901a, Paragraph 1, Clause 2, Section 1901, Paragraph 3 of the German Civil Code).

If all the prerequisites for an effective living will are not met or the living will does not apply to the specific living and treatment situation, it depends on the treatment requests or the presumed will of the person concerned ( Section 1901a (2) BGB). This is a conversation between doctor and supervisor in accordance with To determine § 1901b BGB.

If the doctor and the supervisor cannot agree that a treatment measure corresponds to the will of the person being cared for as determined in accordance with § 1901a, this must be done according to Section 1904, Paragraph 2, Section 1901a, Paragraph 2 of the German Civil Code require the approval of the Supervision Court if the measure is medically indicated and there is a justified risk that the person being cared for will die due to the failure to take place or the termination of the measure.

According to the will of the legislature, the Third Act on the Amendment of Childcare Law of 2009 is intended to ensure that court approval is only required in cases of conflict. If there is no suspicion of abuse, the implementation of the patient's will should not be encumbered by a supervisory court procedure that may involve several instances. Even in the case of an agreement, however, court approval can be applied for in order to legitimize the decision of the supervisor in a judicial procedure and to relieve him subjectively as well as to impart his decision objectively to other parties involved and to protect him from the risk of a deviating ex-post criminal assessment to protect.

Other meanings

Outside of the care law, the treatment request can be an indicator of a patient's motivation for a certain treatment or express certain expectations ( patient request ), in the context of dysmorphophobia or Munchausen syndrome also pathologically exaggerated.

Hepatitis C Treatment

The question of the extent of a desired treatment can serve to determine the value of symptoms for the patient or (after comprehensive information) to assess the motivation for treatment. The degree of motivation can be “clarified” in practice by making appointments: For example, patients with hepatitis C and a history of intravenous substance use will receive an appointment for their first contact in a few weeks. For those patients who then appear, most treatment centers (provided there are no other contraindications ) assume that they will undergo the physically and psychologically stressful therapy for a sufficiently long time. A strong desire for treatment is therefore regarded as the most important prognostic factor for a successful treatment.

Acceptance of chemotherapy

In a much-cited study by Slevin et al. a. (1990) investigated how great the chances of recovery, prolongation of life and the reduction of unpleasant symptoms would have to be in order to choose a very stressful or less stressful chemotherapy . In summary, it was shown that the patients, in contrast to the treating oncologists , even more to the treating general practitioners, but most of all, in contrast to the caring nursing staff and healthy people, would “reach for every straw”.

Antibiotics for common infections

Although antibiotics are not effective in treating common viral infections and this fact has been pointed out for years, many patients believe that they can alleviate their symptoms by taking them. This attitude has not changed in general in recent years, but at least it has been proven that nothing has changed after an awareness program in New Zealand. Although the groups did not differ in terms of the number of days sick, feverish, or sick leave, the patients who had received an antibiotic believed that this had helped and said they would receive medical treatment for a next similar episode.

Individual evidence

  1. Central ethics committee at the German Medical Association: Information and recommendations on dealing with health care proxy and living wills in everyday medical practice, as of October 25, 2018, p. A 2437.
  2. Bienwald / Sonnenfeld / Hoffmann: Supervision law , 5th edition, § 1901 a BGB marg. 57; Palandt / Götz: BGB , 73rd edition, § 1901 a Rn. 28; Jürgens / Jürgens: care law 5th edition § 1901 a BGB marg. 16; HK-BUR / Bauer, as of July 2011, § 1901 a BGB Rn. 71.
  3. BT print. 16/13314 p. 22 on § 1901 b BGB.
  4. Husebø, Klaschik: palliative care . 4th edition. Springer Medizin Verlag, Heidelberg 2006, ISBN 978-3-540-29888-5 .
  5. cf. Gerald Neitzke: Determination of the patient's will . AINS 2019, pp. 474-483.
  6. cf. The living will: experiences and requirements from a medical and legal perspective Joint colloquium of the North Rhine Medical Association and the Rhenish Chamber of Notaries (no year), chart p. 5.
  7. Patients' right to self-determination . ( Memento of the original from February 27, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 88 kB) Guideline of the DRK Clinics Berlin @1@ 2Template: Webachiv / IABot /
  8. BGH, decision of 17 September 2014 - XII ZB 202/13 paragraph. 24 f.
  9. R. Körfer, G. Kleikamp: What treatment request does the patient have in terms of surgery in old age and what can surgery achieve - from the point of view of cardiac surgery , in: W. Hartel (Ed.): Safeguarding the stock, change and progress of Surgery. Langenbeck's archive for surgery. Springer, Berlin and Heidelberg 1996, pp. 434-438.
  10. Filtered images affect desire for cosmetic surgery German doctors Journal , June 25 of 2019.
  11. ^ A retrospective study concerning TMD with regard to pain associated and psycho-social aspects
  12. How and when should one treat hepatitis C? SEVHEP
  13. ML Slevin, L. Stubbs, HJ Plant, P. Wilson, WM Gregory, PJ Armes, SM Downer: Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. In: BMJ (Clinical research ed.). Volume 300, Number 6737, June 1990, pp. 1458-1460, PMID 2379006 , PMC 1663147 (free full text).
  14. B Arroll, T Kenealy: Antibiotics for the common cold and acute purulent rhinitis . ( Memento from January 19, 2010 in the Internet Archive ) Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No .: CD000247 ( ).
  15. M. Curry et al .: Public views and use of antibiotics for the common cold before and after an education campaign in New Zealand . ( Memento of the original from May 23, 2010 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. In: NZ Med J. , 2006 May 5,119 (1233), S. U1957, PMID 16680174 @1@ 2Template: Webachiv / IABot /
  16. P. Little, I. Williamson et al .: Open randomized trial of prescribing strategies in managing sore throat . In: BMJ , 1997 Mar 8, 314 (7082), pp. 722-727, PMID 9116551
  17. P. Little, C. Gould et al .: Reattendance and complications in a randomized trial of prescribing strategies for sore throat: the medicalizing effect of prescribing antibiotics . In: BMJ , 1997 Aug 9, 315 (7104), pp. 350-352, PMID 9270458