We Must Act Now, Before It Is Too Late
It is high time that this subject was raised! Reticence is misplaced, because when the authors mention the “gray areas in deciding whether procedures are indicated” (1), this is no less than a euphemism vis-à-vis everyday experiences: the areas are black! In a medium-sized cardiological practice, nearly every day we see patients who have received pacemakers or implantable cardioverter defibrillators (ICDs) under the widest possible indication or even in the absence of an indication (e.g. pacemakers in digitalis overdose, ICDs on initial presentation with reduced left ventricular function without adequate/appropriate treatment or in myocarditis).
Beyond the ethical and criminal legal aspects, it is quite understandable that young doctors find little joy in their hospital jobs when they must obtain consent for such procedures—under pressure from above. The exodus abroad or withdrawal from medicine altogether is the inevitable result. Thus, there are many reasons to discuss such practices—and especially to act against them, before the reputation of the medical profession is irrevocably damaged.
Dr. med. Michael Kuklinski
|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|