Ethische Aspekte in der Therapie kritisch kranker Tumorpatienten

Tumor patients in need of critical care medicine often ignite discussions between hemato-oncologists and intensive care physicians regarding benefit, reason and objectives of intensive care therapy gainst the background of narrow resources. But a general limitation of intensive care measures in oncological patients is neither medically nor ethically justified. As a basic principle the patient’s will is pivotal for the implementation or omission of intensive care measures, but a medical therapy that is not indicated does not have to be offered by the caring physicians. In situations where the patient can not be asked due to medical reasons (unconsciousness, confusion, sedation, etc.), appropriate means to find out his will (advance directives of the patient, discussions with family members, etc.) have to be used. In cases with foreseeable course of disease a dialogue at an early stage between the patient and the caring physician about prognosis of the disease and therapeutical and personal goals of the patient should be encouraged. In everyday life advance directives are lacking in most cases. Moreover due to their more general character their usefulness in concrete medical situations is limited. Therefore we recommend in all medical situations a stepwise procedure when the patient is in need of intensive care but where either the medical basis for decision or the patient’s will is unclear. Initially all necessary intensive care measures should be started to offer the patient every option he needs and to obtain time for the intensive care physician to gather all necessary information and to enter into a discussion with family members and all physicians looking after the patient. The clinical situation of the patient should be reevaluted on a regular basis giving the therapeutic team (i.e. the intensive care team and all physicians involved in the treatment of the patient) the option to adapt their measures according to the decision- relevant facts.