Synonym(s)
Operational Reconnaissance
General informationThis section has been translated automatically.
I Content of the guidelines
- According to established case law, any medical intervention into physical integrity is considered to be bodily injury. In principle, it is only legal if the patient has been informed about the intervention, has consented to the intervention after being informed and the intervention has been carried out professionally. Consent is not required if the intervention must be performed immediately to avert an imminent danger to the patient and prior consent could not be obtained because of the patient's physical or mental condition.
- As a prerequisite for legally effective consent, the patient must be informed - unless he/she waives this - about the aim, scope, necessity and urgency, type and course of a medical examination and treatment measure as well as the associated risks.
- On the one hand, the patient must have knowledge of his or her illness and its dangers, and on the other hand knowledge of the treatment and its unavoidable consequences, in order to be able to weigh up and decide properly.
- Since the informative discussion and the patient's consent are of legal significance, documentation is indispensable in this respect.
- Every hospital operator must ensure that the principles developed by the courts for informing patients before medical examination or treatment measures are carried out are observed. Every physician must orientate his or her educational talk to the requirements of this jurisdiction.
- The following Section II therefore summarises the main features of these requirements of case law in the form of guidelines.
- Section III contains a list of organizational measures that are necessary to ensure that patients in hospital are adequately informed before medical examination and treatment measures are carried out.
- The "safety education" (education following a medical examination and treatment measure to ensure the success of treatment or avoidance of damage to health) and the "diagnostic education" (education of the patient about the nature and severity of his or her suffering regardless of whether or not he or she consents to a diagnostic or therapeutic intervention) are not the subject of this guideline. The same applies to the specificities of information provided in the context of coercive treatment (in particular where the patient is placed in a mental health facility).
- 1. the information interview must be carried out by the doctor; it may not be delegated to non-medical service staff The doctor who conducts a medical examination or treatment does not have to provide information if this information has already been provided by another doctor; however, he must be clear about this.
- 2. the information must be provided individually in a conversation with the patient The informative discussion cannot be replaced by forms. Forms only serve to prepare and document the interview.
- 3 The physician must inform the patient about the main features of the planned examination or treatment, but not about details. The requirements for the extent of information depend on the urgency of the intervention and the patient's level of education and knowledge.
- 4. information shall be provided on risks specifically associated with the nature of the intervention (typical risks), irrespective of the rate of complications; for other risks (atypical risks), information shall be provided on the rate of complications.
- (5) Where several scientifically recognised methods are seriously considered, the information provided must include these alternative methods of examination and treatment and their risks. This does not apply if the chosen method is within the range of scientifically recognized therapy and the available and recognized treatment option does not promise a significantly lower risk.
- 6) If there is a possibility that a blood transfusion may be required during an operation, the patient shall be informed about the risks of infection (in particular hepatitis and HIV) when using foreign blood.
- If the use of the patient's own blood is possible, the patient must be informed in good time so that appropriate blood reserves can be made.
- 7. the information must be given at a time when the patient is still in full possession of his faculties of knowledge and decision; he must be given a period of reflection, if the urgency of the measures allows this
- 8. the information must be provided in a way which is gentle and comprehensible to the patient In a personal conversation, the physician should endeavour to adapt the information to the patient's individual capacity for comprehension and level of knowledge and at the same time make sure that the patient understands it.
- If it is not certain that a foreign patient understands the explanations, the doctor must consult a person who is familiar with the language.
- If the patient's consent to an examination or treatment measure involving risks can only be obtained by the doctor drawing his attention to the nature and significance of his illness, the doctor must not shy away from this, even in the case of serious illnesses. In all other respects, however, he is not obliged to give a complete and unsparing explanation of the nature of suffering, but must observe the commandments of humanity and take into account the physical and mental condition of his patient when giving his information.
- (9) The consent given by a patient on the basis of the information provided covers only those interventions which have been the subject of the information provided. If it is foreseeable to the physician that a surgical intervention may have to be extended to other areas, the patient must be informed about this before the intervention. If it only becomes apparent during an operation that further surgery is necessary, the physician must weigh the risks of interrupting the operation against the risks of carrying out the further surgery, and then make his or her decision to interrupt the operation in order to obtain the patient's consent.
- 10) In the case of minors, the consent to the surgery must normally be obtained from the parents or other guardians or their representatives. In certain exceptional cases, such as urgent or emergency measures as well as interventions of minor importance, it is sufficient if the consent of only one parent is available. However, adolescents under the age of 18 shall exceptionally have the power of consent if they are sufficiently mature to measure the significance and scope of the intervention and its authorisation. In any case, however, children and adolescents must also be informed in broad outlines of the intended intervention and its course, if and to the extent that they are able to understand the medical measures. The same applies to the education of patients who are legally incompetent or have limited legal capacity; here the consent of the carer must usually be obtained.
- 11) Mentally ill or mentally ill persons shall be informed in broad outlines of the planned intervention and its course, if and insofar as they are able to understand the meaning and consequences.
- 12. in the case of unconscious patients, the doctor shall carry out those medical measures which are necessary in the patient's interest to restore his or her health (presumed consent). In order to find out the real or presumed will of the patient, it may be advisable to talk to persons particularly close to the patient; statements made in writing by the patient may also be an indication of his presumed will. In the case of suicide patients, no presumed will to refrain from medical assistance can be deduced from the suicide attempt. As soon as and to the extent that the patient's ability to consent is restored, his consent must be obtained in order to continue treatment.
- 13) If the patient clearly indicates that he does not wish to be informed (waiver of information), this may be omitted.
- The medical director is responsible to the hospital operator to ensure, in cooperation with the hospital's senior physicians, that all physicians working in the hospital are informed of the obligations imposed on them in connection with the information in accordance with these guidelines.
- 2. the medical director, together with the senior physicians of the hospital department (chief physicians and attending physicians), shall determine in which department the information on examination and treatment measures is to be provided if a patient is being treated in several departments at the same time or successively, unless information is required in each department anyway.
- (3) Each senior departmental physician shall ensure the proper conduct of the information for his department, and in particular shall determine which physician shall conduct the information. It must be ensured that education is also required prior to individual interventions involving additional risks, if they have not already been the subject of an earlier educational discussion; this also applies to diagnostic interventions.
- (4) Irrespective of paragraphs 2 and 3, any doctor who does not educate himself must satisfy himself that proper education has taken place.
- 5. the head department physician shall ensure that the fact of the clarification and the essential content of the clarification discussion are properly documented. The fact of the clarification, its timing and the essential content of the clarification discussion should be recorded in the medical history. In a written declaration of consent, the patient should confirm by signature that the clarification has taken place, a possible waiver of clarification and the essential content of the clarification. The clarification discussion cannot be replaced by a declaration of consent according to the form.
Prof. Dr. med. Peter Altmeyer