As of: March 28, 2024, 11:54 a.m
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As an acute hospital, the Asklepios Clinic's staff have the task of putting patients in the same or better condition as they were before they were admitted. © Schmedemann
A woman complains about how her father, who has cancer, was treated at the Asklepios Clinic in Langen. The problem: The family had neither a living will nor a power of attorney for health care.
Langen - When people come to the hospital as an emergency, it is an exceptional situation for those affected - not only for the patient themselves, but also for their relatives. If the prospects are bad, even more so. When Dany Rüssli's 80-year-old father, who until then had lived alone and fairly independently, was hospitalized, it was a terrible blow to his daughter. Although she knows that her father has had cancer for many years, the deterioration in his condition still comes as a surprise. He was admitted to the Asklepios Clinic in Langen, where he never left alive. “Those were ten very unpleasant days,” says Rüssli, who only spent one of them out of the hospital.
A period of time that, in her daughter's eyes, shouldn't have been so long. Ultimately, palliative measures are initiated that enable the father to fall asleep. By the time the time came, he had already been in the hospital for more than a week. “The blood values spoke for themselves – he could have been rescued earlier,” believes Rüssli. It was a ten-day agony. She also criticizes that the father was in unnecessary pain and that no doctor was there at the weekend to revise the medication plan.
Relatives have no decision-making power
But the main problem: the father is initially no longer able to express himself and make decisions about the course of treatment. He did not write a living will. Dany Rüssli and her sister do not have a power of attorney either. Although they are the next of kin, they have no decision-making power. Then the father falls into a coma because his condition worsens again. Rüssli is certain: “My father was always independent - I just knew that he didn't want any further measures.” But because this wish was not recorded anywhere, it doesn't count that Rüssli represents her father's opinion. “We wanted him to be moved to a palliative care facility. But that didn’t happen.” The father regains his strength through artificial nutrition via a tube. At least to the point where he can finally make a final decision for himself: that he no longer wants any further treatment.
It is a situation that strains the nerves of the relatives. However, in a conversation with Dr. Albrecht Römer from the Asklepios Clinic. The cardiologist cared for his father until the end. “First and foremost, we are an acute care hospital. We want the patient to leave in the same condition as before the illness. Or even a better one,” he says. In the doctor's eyes, the values mentioned by Rüssli were not so bad that they could not have been improved. “In the end, it is the doctors who are responsible for a decision – or an end. We never make decisions alone,” emphasizes Römer. The first priority is to alleviate suffering; this determines the goal of therapy.
A power of attorney is the best thing you can have. In combination with a living will, it also makes our work easier for doctors.
Chief physician Dr. Michael Schütz
If an emergency comes in, you first have to “get to know” the patient. In contrast to relatives, doctors often know: nothing. Information from the family doctor and treating specialists is then used to get as comprehensive a picture as possible. “Mrs Rüssli had the wrong impression: of course senior doctors are also on duty at the weekend. Of course, when you ask your family doctor, the weekend sometimes gets in the way,” says Dr. Michael Schütz, chief physician of anesthesia and interdisciplinary intensive care medicine. It takes time until a comprehensive picture of the patient is available. The doctor can understand that for relatives this feels like a never-ending eternity in which nothing happens. Dialogue is therefore particularly important to him: “Today, relatives are much better integrated than they were 30 years ago.”
Nevertheless, the legal framework remains. Schütz emphasizes: “A health care power of attorney is the best thing you can have.” In combination with a living will, it also makes the work of doctors easier (see box). Römer makes it clear: “There are medical cases that are as clear as day, such as a heart attack. But often things have to be weighed up individually.” A wrong decision is terrible. Dany Rüssli says: “It caught me off guard. I will now take precautions so that my children do not end up in the same situation later.”
Act in the interest of the patient
A living will specifies how you want to be treated medically if you can no longer express this wish yourself. This may include life support measures and organ donation. With a health care power of attorney, a person of trust is appointed who acts on their behalf and is allowed to make decisions - for the doctors it is as if they were speaking directly to the patient, also legally. The living will, in turn, can help this confidant to act in the interests of the patient. A power of attorney is issued in writing; notarization is advisable. If none of this applies, a legal representative is appointed and acts according to the patient's presumed wishes. Relatives cannot influence this. (liz)