[The physician in the malpractice suit. (2) How does the patient have to be informed?].
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Biomedical subjects
Publications and source records attributed to W Weissauer.
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The objects, aims and methods of research are protected from political misappropriation. But the freedom of research is limited by the clash with the legally protected third party, especially in the law of integrity of life and limb. To protect the environment from the (hypothetical) epidemiological dangers of gene technology the legislator has limited himself to measures by which he can obtain this aim with the least infringement of freedom of research. Gene technological intervention in human idioplasm is apparently not yet serious. Nevertheless the ethical and legal problems which arise form the point of view of human dignity from experiment with human genetic material should be discussed now.
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In order to establish liability there must be a causal connection between an objectively erroneous action and the ensuing damage. Criminal negligence presupposes that failure on the part of the anaesthetist to exercise the necessary care, including neglect properly to choose and supervise his assistants, is responsible for the mishap. Since anaesthesia constitutes a trespass to a person's body the consent of the patient has to be obtained. Such consent is valid only if the patient has been apprised of the nature, significance and risks of the anaesthetic method to be used. The anaesthetist must inform the patient whether general or regional anaesthesia is planned. The extent to which such information must be supplied and proof that it has been given may present difficulties. A practical approach is to provide the patient with as much information as will enable him to ask relevant questions and then to decide whether or not he wants further explanations.
A stepwise explanatory process is proposed: through a brochure in which the type, significance, and, for the cautious patient, the major as well as minor risks are described (1st step), through a conference in which the individual circumstances are considered and the patient has the opportunity to ask more detailed questions (2nd step). The patient should guarantee in writing that he received the brochure, that he does or does not wish further explanation of the risks, that he consents to the operation and to necessary changes or elaborations.
In the interdisciplinary cooperation between the surgeon and the anesthetist, the following factors are in effect: the principle of strict division of labor; each brings the functions of his specialty and carries complete responsibility for them; the principle of trust: each can depend on the meticulousness of the other, as long as no obvious qualification deficiencies are apparent; obligation for coordination: each must accommodate himself to the requirements of the other specialty.
According to the principles developed by the legislature, the treatment of cancer requires particularly careful diagnosis. The principle of free choise of methods is accepted in the treatment of cancer; in many cases, however, surgery plus irradiation must be regarded as the method generally accepted as the most effective, of which the doctor regularly has to avail himself. Revelation of the diagnosis involves particular problems. If telling the patient of the diagnosis likely to have a deleterious effect on the results of treatment, the type and extent of information given to the patient must be left to the discretion of the doctor.
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