Palliative Care as an Area of Conflict
I very much welcome the fact that Deutsches Ärzteblatt has introduced the controversial conflict of “commercial pressures versus ethical/medical responsibility” into the public discourse (1). In my opinion, the long neglected implementation of palliative care structures into German hospitals and care homes provides a further example of this conflict.
In November 2015, the Hospice and Palliative Care Act (2) was passed by the German Bundestag; the law prohibiting the promotion of assisted suicide (3) was passed the day after—palliative medicine and hospice services are therefore the legislator’s “alternative” offering to the most severely ill persons, rather than provision of assisted suicide. The law was intended to provide for “nationwide palliative care and hospice services in Germany, by means of targeted measures on the part of the statutory health insurers and social care insurers,” and to provide “incentives for the further setting up and extending of hospice and palliative services,” which “strengthen palliative care services and hospice culture in inpatient nursing institutions and hospitals [...] (2). Unfortunately, no concrete targets or requirements were formulated for health insurers, hospitals, and care institutions, and possible funding options were not addressed either. In 2018, the situation, at least in hospitals and care institutions, is no different to what it was before the law was passed in 2015. Only very few hospitals or care homes are structured in such a way that they are able to provide palliative medical care. The reason for this is that such services do not make financial sense—the costs incurred are too high and the profits too low.
For society as a whole, the systematic provision of palliative medical care services is likely to constitute a cost saving, because expensive operative procedures, chemo- and immunotherapies, or intensive care measures with sometimes questionable indications would probably not be undertaken; however, hospital owners would probably suffer financially as profitable procedures would be stopped earlier or would not be attempted at all.
Dr. med. Franz Fehlings
|1.||Wehkamp KH, Naegler H: The commercialization of patient-related decision-making in hospitals—a qualitative study of the perceptions of doctors and chief executive officers. Dtsch Arztebl Int 2017; 114: 797–804 VOLLTEXT|