Transcript palliativ care in general practice

ETHICAL DILEMMAS
of raising needs versus limited
resources
Manfred Maier
CONTENT
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reasons for raising needs
aspects of resources
ethical dilemmas
principles of solutions
LEARNING GOALS
• explain same developments which
challenge our resources
• discuss some ethical dilemmas
arising from biomedical / social
developments
RAISING NEEDS IN HEALTH
CARE
• demographic developments
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increased life expectancy
increased elderly population
increase in chronic diseases
new diseases
increase in multi- morbid patients
new epidemics
reduction in birth rate
increased risks due to leisure time
activities
RAISING NEEDS
• biomedical developments
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technical developments (PET,…)
diagnostic / therapeutic improvements
Increased requirement for resources
new medications
screening – prevention – health promotion
palliative care
guidelines
quality improvement measures
information technology
individualized treatment
(pharmacogenomics)
LIMITED RESOURCES
• financial resources
– reimbursement system
• structural resources
– Health insurance, HC- systems, group
practices, facilities
• personnel resources
– imbalance of health care professionals,
generalists - specialists, health care teams
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not all goals can be reached at
the same time
• ECONOMIC RESOURCES
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Education
Environment
• Prevention
continued
payment
of wages
• accidents
sickness
• immunization
handicapped
Health Care
Safety
Curative Medicine
Rehabilitation
diagnostics
medical
therapy
social
nursing
inpatient
advising
ETHICAL PRINCIPLES
• Primacy of patient
welfare
• Patient autonomy
• Social justice
Hippocrates
(460-380 bc)
ETHICAL DILEMMAS
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demanding patients
patients in need
guideline requirements
genetic diagnostics
screening procedures – prevention –
medicalization
palliative care
defensive medicine
to many duties in GP /FM – time limited
public health care – private insurance
economic forces – ethical principles
overuse – misuse – underuse of resources
SOLUTIONS
• setting of goals for health care
• setting priorities
• provision of health care where it is
most efficient
• communication with the public and with
the patient
• transparency in health care