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Übertherapie in der Intensivmedizin

  • W. Druml
  • C. DrumlEmail author
Leitthema

Zusammenfassung

Übertherapie – als eine nicht indizierte oder vom Patienten nicht gewünschte Therapie und Diagnostik („non-beneficial therapy“) – ist ein inhärentes und schwerwiegendes Problem der modernen Medizin und insbesondere der Intensivmedizin. Übertherapie zieht sich durch alle Bereiche der Intensivmedizin, kann schon am Notfallort beginnen, betrifft (ungerechtfertigte) Aufnahmen auf die Intensivstation, die Überdiagnostik und vor allem die Blutabnahmen, eine überhöhte Invasivität oder den inadäquaten Einsatz maschineller Verfahren. Sie manifestiert sich an einem „Zuviel“ an Sedierung, Relaxation, Volumengabe, Sauerstoff, Kreislauftherapie, an Blutprodukten, Antibiotika und anderen Medikamenten und Ernährung. Übertherapie betrifft aber insbesondere auch das Lebensende, wenn ein kuratives Therapieziel nicht mehr erreicht werden kann. Übertherapie hat wesentliche ethische Implikationen, missachtet alle 4 medizinethischen Grundsätze, die Autonomie, Würde und Integrität der Patienten, ist mit keiner Benefizienz verbunden, steigert Schmerz, Leid, verlängert Sterben, vermehrt das Leid von Angehörigen, führt zu Frustrationen im Team, missachtet die Verteilungsgerechtigkeit und schädigt bei prinzipiell limitierten Ressourcen die Gesellschaft insgesamt. Sie ist auch ein rechtliches Problem geworden und kann als Verursachung ungerechtfertigten Leides juristisch geahndet werden. Übertherapie ist schlechte Medizin, kein Kavaliersdelikt; alle müssen kontinuierlich daran arbeiten, eine nichtgerechtfertigte Therapie zu vermeiden.

Schlüsselwörter

Nicht-indizierte Therapie Überdiagnose Invasivität Medizinethik Therapie am Lebensende 

Overtreatment in intensive care medicine

Abstract

Overtreatment, which is therapy that is neither indicated nor desired by the patient (“non-beneficial”), presents an inherent and huge problem of modern medicine and intensive care medicine in particular. Overtreatment concerns all aspects of intensive care medicine, may start already before admission at the emergency scene, the inappropriate admission to the intensive care unit, overuse in diagnostics and especially in blood sampling, in invasive procedures and in organ support therapies. It manifests itself as “too much” in sedation, relaxation, volume therapy, hemodynamic support, blood products, antibiotics and other drugs and nutrition. Most importantly, overtreatment concerns the care of the patients at the end of life when a causal therapy is no longer available. Overtreatment also has important ethical implications and violates the four fundamental principles of medical ethics. It disregards the autonomy, dignity and integrity of the patient, is by definition nonbeneficial and increases pain, suffering, prolongs dying, increases sorrow of relatives, imposes frustration for the caregivers, disregards distributive justice and harms society in general by wasting principally limited resources. Overtreatment has also become an important legal issue and because of imposing inappropriate suffering may lead to prosecution. Overtreatment is poor medicine, is no trivial offence, all must continuously work together to reduce or avoid overtreatment.

Keywords

Non-beneficial therapy Inappropriate diagnostics Invasiveness Medial ethics End-of-life care 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

W. Druml und C. Druml geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für Innere Medizin III, Abteilung für NephrologieAllgemeines Krankenhaus WienWienÖsterreich
  2. 2.Ethik, Sammlungen und Geschichte der MedizinMedizinische Universität WienWienÖsterreich

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