General informationThis section has been translated automatically.
Principles of the medical obligation to inform.
- Freedom of form
:Apart from a few exceptions, there are no specific forms to which the educational discussion must be bound. The patient's signature on an information sheet is only valid as consent in combination with an information conversation understood by the patient. It is best if the patient is first given the form to read through, then asks questions if necessary before signing. - Comprehensibility
:The doctor, as the "knowing one", must choose the way the conversation is conducted in accordance with the mental and intellectual level of the patient. Incomprehensible foreign words should, from a purely legal point of view, be avoided or explained. In the case of foreigners who have no or only limited knowledge of the German language, the corresponding explanatory sheet must be translated or an interpreter must be called in if serious surgery is involved that could result in death, blindness, paralysis, organ loss or considerable loss of quality of life. In the other cases, translation by relatives is possible, but there is a risk that something is not exemplified precisely enough for the patient and his/her consent is therefore legally invalid. - Time of clarification
:The patient must have enough time to weigh up his decision in peace after the clarification discussion; the decision-making process may also include a discussion with relatives or another doctor. Under no circumstances should the consultation take place shortly before the operation, not even in the case of outpatient surgery. - Informing inaccessible patients
:In the case of unconscious or artificially ventilated patients in the intensive care unit, but also in the case of severely shocked patients who are therefore not accessible for an informative discussion, the attending physician can assume that the patient is "presumably" in agreement with all measures that will save his life. It may be advisable to consult a specialist colleague who will make a note in the patient's medical records of the patient's condition. - Respect for the patient's right of self-determination
:The doctor must clearly show and describe to the patient real, actually existing therapy and diagnostic alternatives. He must not influence the patient unilaterally with regard to a method so that the patient has no real choice. - Scope of information
:The patient only needs to know in broad outline what is to be done with him. The doctor should therefore discuss the nature, the usual course and the associated consequences or risks, but also the expected benefits with his patient. - Scope according to urgency
:The more urgent the intervention is, the more the duty to inform takes a back seat, e.g. if life is in danger. For interventions that are not acutely necessary, a detailed explanation is provided. - Grading according to purpose
:In the case of diagnostic procedures, especially with invasive techniques, which do not bring any direct therapeutic benefit, the highest duty to inform is established, comparable to a cosmetic operation which is not medically indicated. - Indication of possible complications
:The more serious the consequences of the intervention can be (death, blindness, paralysis, loss of organs, deterioration in quality of life, etc.), the more intensively the consequences typical of the intervention must be pointed out, even if they can be in the per mille range. - Limits of the duty to inform in the case of mental impairment
:If the patient is threatened with serious mental health disorders and damage (e.g. severe depression, attempted suicide, etc.), the information can be completely or partially omitted. The doctor can decide this himself. He does not have to write a note about it in the medical file. - Waiver of information
:Every patient can forgo medical information for various reasons (e.g. great fear of the operation). This renunciation should be made in writing. The doctor should write a short note in the medical records.
Problem: Obligation to inform also the referring doctor.
The referring doctor must also inform the patient about the recommended procedure and its risks. He cannot and need not say anything about possible consequences of the operation, which depend on the personal qualification of the colleague performing the operation. - Operation extension
:If the doctor comes to the conclusion during the operation that an extension of the operation plan is necessary, which is not dependent on the patient's consent, he can only continue the operation if - he was subject to a non culpable preoperative diagnostic error
- the new findings lead to the death of the patient in the foreseeable future without deviation from the surgical plan
- the abortion of the operation for the purpose of further clarification is seriously associated with additional dangerous complications which would not arise if the operation were continued immediately
- the patient is not expected to object to the extension of the operation due to the life-threatening nature of the new findings.
- Minors
:The declaration of consent depends on the maturity, understanding, age of the person and the importance of the operation. Up to about 12-14 years of age, the right to give consent should lie exclusively with the parents. After that the opinion of the minor is more and more important and the parents' right to have a say in this highly personal decision is dwindling more and more. - Mentally pre-aged and handicapped patients
:A guardianship court should be called in in good time before major interventions and dangerous treatments. - Documentation of the clarification discussion
:If a physician does not document, does not document comprehensively or does not document in a timely manner, he or she runs the risk of disadvantages arising from improper documentation during the trial, which could lead to a reversal of the burden of proof. Hence the recommendation to provide the patient's signed information sheet with personal notes on the interview, including place, date, duration of the interview and time, and to keep it carefully. - Delegation of the obligation to provide information
:Delegating the information interview to non-medical staff does not accept the jurisdiction. The person performing the procedure may delegate the duty of information. However, who delegates is liable if the performer forgets to mention a specific risk or inadvertently fails to provide clarification.
LiteratureThis section has been translated automatically.
- McKevitt C et al (2003) Defining and using quality of life: a survey of health care professionals. Clin Rehabil 17: 865-870
- Rogers WA et al (2003) Confidentiality and the ethics of medical ethics. J Med Ethics 29: 220-224
- Schlund GH (1997) Education in the context of medical activities. dermatologist 48: 870-873
Prof. Dr. med. Peter Altmeyer