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Between Over-Treatment and Under-Treatment, ethical Problems of Micro-Allocation Taking Intensive and Geriatric Care as Examples

Research Project
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01.12.2006
 - 30.11.2008

Quality Development in Medical and Nursing Care Through a Modular, Ethical Treatment Allocation Process (METAP) in Vulnerable Patient Groups Project summary: Vulnerable patient groups face several risks that are of ethical relevance. Over-treatment in the light of unfavourable prognosis as well as under-treatment regarding providing palliative care until the end of life can be observed. Difficulties that the staff may have with the decision-making process regarding limitation of treatment, possibly under economic pressure, may trigger moral distress. Evidence for these phenomena was found in national and international literature, as well as in our own previous research. Ethical aspects need to be integrated in practical models dedicated to problem solution. This shall be carried out in a paradigmatic way in the fields of intensive and geriatric patient care, combined with the effort to create a general model for clinical ethical decision-making. It is planned to elaborate a multidimensional model consisting of several modules for clinical ethical decision-making on the ward that can improve quality in several ways by increasing participation of the staff involved, creating or supporting transparency, appropriately and reliably respecting the needs and rights of patients, including the involvement of relatives, integrating clinical and ethical aspects. The project works with different methods from social science to be applied to clinical ethics research. Both the empirical data as well as the practical experiences of developing, implementing, observing and evaluating the instrument, will be submitted to rigorous ethical analysis, especially from the point of view of the ethics of allocation. Vulnerable patients such as the severely ill, old and dying, require particular attention and protection. Although the risks of over-treatment as well as under-treatment are now being acknowledged, their ethical significance has not been sufficiently addressed and elaborated. The same is also true for the perception of economic pressure at the bedside, where many questions remain open. Issues of micro-allocation ethics require a practically relevant clinical ethical investigation, an approach that has been greatly neglected. These objectives will be in the center of the project. The model to be developed in the project will contribute to better meeting and managing these challenges in the clinical setting, in an ethically reflected and participative manner. After completion of the project, the model will be made available to other clinical institutions for their use.

Publications

Lenherr, Gabriel et al. (2012) ‘To speak, or not to speak - do clinicians speak about dying and death with geriatric patients at the end of life?’, Swiss medical weekly, 142, p. w13563. Available at: https://doi.org/10.4414/smw.2012.13563.

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Albisser, H and Reiter-Theil, S (2011) ‘Ethische Fragen in der Geriatrie: Ist ‘Altersrationierung’ ethisch vertretbar?’, Pro Alter, Mai/Juni, pp. 39–42.

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Albisser, H and Reiter-Theil, S (2011) ‘Ethische Fragen in der Geriatrie (2) Altersrationierung - wissenschaftliche Evidenz und ethische Analyse.’, Geriatrie Praxis, 4, pp. 44–45.

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Albisser Schleger, Heidi, Oehninger, Nicole R and Reiter-Theil, Stella (2011) ‘Avoiding bias in medical ethical decision-making : Lessons to be learnt from psychology research’, Medicine, health care and philosophy, 14(2), pp. 155–62. Available at: https://doi.org/10.1007/s11019-010-9263-2.

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Meyer-Zehnder, B and Reiter-Theil, S (2011) ‘Ethische Fragen in der Geriatrie (1) ... und wo kein Wille mehr ist, lässt sich dennoch ein Weg finden’, Hessisches Ärzteblatt, 6, pp. 349–352.

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Reiter-Theil, S (2011) ‘Fairness und der angemessene Einsatz von Ressourcen am Krankenbett - ethische Aspekte empirischer Daten’, DIVI, 2(4), pp. 158–164.

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Reiter-Theil, S et al. (2011) ‘Klinische Ethik als Partnerschaft - oder wie eine ethische Leitlinie für den patientengerechten Einsatz von Ressourcen entwickelt und implementiert werden kann’, Ethik in der Medizin, 23,2, pp. 93–105. Available at: https://doi.org/10.1007/s00481-010-0098-4.

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Albisser, H., Oehninger. N. R. and Reiter-Theil, S. (2011) ‘Vermeiden von Denkfehlern bei ethischen Beratungsprozessen : Lektionen aus der psychologischen Entscheidungsforschung’, in Stutzki, Ralf; Ohnsorge, Kathrin; Reiter-Theil, Stella (ed.) Ethikkonsultation heute - vom Modell zur Praxis. Zürich: LIT Verlag (Ethik in der Praxis. Studien), p. S. 95–117.

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Meyer-Zehnder, B and Reiter-Theil, S (2010) ‘Ethische Fragen in der Geriatrie (1) ... und wo kein Wille mehr ist, lässt sich dennoch ein Weg finden.’, Geriatrie Praxis, 12, pp. 43–45.

Meyer-Zehnder, B., Pargger, H. and Reiter-Theil, S. (2007) ‘Folgt der Ablauf von Therapiebegrenzungen auf einer Intensivstation einem Muster?’, Intensivmedizin und Notfallmedizin, 44(7), pp. 429–437. Available at: https://doi.org/10.1007/s00390-007-0813-7.

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Members (7)

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Stella Reiter-Theil

Principal Investigator
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Hans Pargger

Co-Investigator
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Heidi Albisser Schleger

Project Member
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Barbara Meyer-Zehnder

Project Member
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Jan Matthias Schürmann

Project Member
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Sabine Tanner

Project Member
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