Advocate the Thanoss ideology

Eu thanos - medicine and ethics at the limit of life



Eu thatatos





Table of Contents

Archbishop Hats-Josef Becker

Eu thatatos - medicineandethics

attheborderofLife ......................................................... 2

Dr. med. Mr. matn-Josef Pielken

Euthanasia versus palliative medicine .............................................. 6

Prof. Dr. theol. Klaus Arntz

Freedom in the end ofLife

Ethical remarks on the euthanasia debate ............... 17

Dr. med. Peter Liese

Is politics binding or similar?the there are ethical scriptsatken? .......... 33

Biographical information on the speakers .............................. 42

Documentation the Medical days ................................................ 43

Ed .: Archbishop's General Vicariate

Department of Pastoral Services

Editor: Dr. Werner Sosna

Cathedral Square 3

33098 Patheborn


Eu thatatos


Opening words

by Archbishop Hats-Josef Becker

For this year's Doctors' Day here in the Kaiserpfalz Patheborn, the

has now established itself as a good tradition, I extend a warm welcome to you

welcome. Again we dedicate ourselves to this interdisciplinary forum

a question of the highest social relevanceatz who have been using for years

ever stronger intensity in our Latd is performed. It hatdelt

about a problem for which we socially

want binding regulation that comes with the Would of People at

End of his Life must be compatible. I'll see you with one

Euthatas the debate faced, in the the Catholic Church does not

may be silent and which we are therefore right to comment in

Look at the ethical legitimacy of our H.atdelns outthet. Because

the same applies here the Sizeandsentence that not all for what the single person

and society as a whole are capable of doing well at the same time as being allowed and

ethically legitimate atcan be seen. For this Grand let's face

today a topic that brings us to the unavoidable question:

"Which dying really does justice to a person?"

This question is not only urgent to us atface the political

Setting the course in our western neighborsthen up, sonthen

also because us the medical and technical progress at the same time

Situations pose katn, viewed in the light, an extension of

Dying and Cause human suffering. So much the stronger

as you know, if this is used as an argument, the active euthanasia

also in our Latd door and Gate open.

At the same time, sober demographics put us in this situation

Numbers in the atGuest-occupied weighing the high cost, the one

medical care in old age and at the Lifeend caused. A

Weighing up, apparently betweenatcommon and as if from invisible

Hatd led, suddenly with the apparently "inexpensive" alternative the

active euthanasia presented a supposed "solution model". There

we need to be clear that this “magic word” is nothing

attheit as the conscious and means targeted killing of a person. The

there is a social consensus on the use of active euthanasia


fortunately not yet agreed. I would like at this point, however

do not hide the fact that concern is growing, that one too

Step could be taken by the legislature to LifeLaw

of People at this stage of its existence seem to preserve it

but - as at the beginningatG ofLife - to the social

To provide disposition.

Of course, it is foreseeable that the number of old, often heavilyatker

Othe people in need of care in the coming decades

will increase significantly. But it would be disastrous if we look in

consent to active euthanasia is the only one for such problems

socially possible answer to a certain problem congestion

atwould see. The German Bishops' Conference and the Evatgelische

Church Deutschlatds have in their most recent letter on this issue

expressly stated that we are in favor of a “strengthening the Alternatives "

to plead. 1 Because in our eyes too much is at stake! A

Society that is ready to go through certain phases of human Life

the calculation the Subjugating usefulness has respect for that

human life in its unity and Gatlong ago given up.

As early as 1975 (!) The German bishops wrote “Das

LifeLaw of People and the Euthatasie “on this ominous

Cohesionatg alerted: “If only after his life

private and social benefit is assessed, datn it is at most one

question the time andof suckedatnth 'people's feeling', which groups

people are affected by this extermination judgment. ”2

My ladies and Men's!

The plea for a so-calledatnten "good death" in the sense the

Euthatthe debate is fraught with the great risk that it will differ from

the Appreciation of human Lifeas she goes through the Christian

The image of man became possible in the first place and at allatis animalized,

detaches. This is the ultimate consequence the Sizeandvalue of human

Life questioned himself: Even Friedrich Nietzsche's "Zarathustra"

I wished for the future "’ Preacher of ring Toof', which the

Kratken, behintheten, yes to all 'superfluous' say: die to the right

1 terminal care instead of active euthanasia. A collection of ecclesiastical declarations [Common

Texts 17], ed. from the church office the possiblyatGelischen Church in Germanyatd and from the secretariat the

German Bishops' Conference, J.atuar 2003, p. 6.

2 The German Bishops (4): That LifeLaw of People and the Euthatasie in: Common

Texts 17, p. 15.


Time! ”3 Of course, we are not meant by this, the Gesanden, strong,

Huge and Guards who are more othe less in full possession of their physical

and spiritual forces participate in life and the central

social calculation the Maximizing costs and benefits is not a burden

fall - more precisely: not yet! But Nietzsche's word would become immediate

relevantatt for those people who - for whatever reasons

always, and not only the age is decisive - these predicates dependatthe

came othe that they never owned!

And this gap is getting bigger and bigger in our society! who wants

preventthen that not only dyingatke, sonthen also Latgzeit patients,

Seriously injured or similartheatthee 'Cost causer' for these case groups

will belong to them instead of social ones and individual help

only the Death is "given" 4.? Given such a perspective

is the word of my fellow brotherthes cardinal clayatn andof former

Chairman the EvatGelischen Church Deutschlatds, President Matfred

Kock, of unmistakably topicality and Urgency: "Where do we

Killing someone as a solution the admittedly difficult

Situation of Kratness and Accept dying, this is a B.atcrotch clarification

at humanity .... we are not allowed to suffer human suffering

by killing, sonthen must give him through human affection and

Counter concern. We want suffering linthen and not us the Sufferers

discard. "5

As churches we do not want to contribute to Kratness and To die

increasingly out of consciousness of mothedisplaced people

become. Because they are part of human life and need to be coped with

become. "Not help to die, sonthen Help in dying we are to him

Kratguilty ”. 6 That is why we are Christians regardless of ours

Denomination, askedthet, us the question of veratverbal Hatdelns at

theborderofLife to deliver.


Alexatthe Lohner, The Spiritual Roots the new bioethicist andthe Zeitgeist, in: Lifeforum 2 /

1998, 26-31


Legalization the active euthanasia in the niethelatthat led to the fact that approx

Patients are actively killed without their consent. See Fuat S. Oduncu, in: Voices the time

128 (2002) p. 128.


Dying care instead of active euthanasia. A collection of ecclesiastical declarations (joint

Texts 17), ed. from the church office the possiblyatGelischen Church in Germanyatd and from the secretariat the

German Bishops' Conference, J.atuar 2003, p. 7.

6 The German Bishops (4): That LifeLaw of People and the Euthatasie in: Common Texts

17, p. 16.


Eu thatatos “- a good one, a satfrequent death! Hardly anyoneatd wish

Saying goodbye to life is not as humble as possibleaten

Wise! And it is precisely for the sake of this perspective that we have to deal with it

ask given questions because the worry the Churches has always been true

especially people in their weakest phases Life, in

which they often no longer have any advocates!

It is my deep conviction that we are here in a common

Veratanswer, we are looking for a humane accompaniment Kratker

and To diethe to use. I'm looking at these considerations the title

chosen for our conference:

Eu thatatos - medicineandethicsattheborderofLife!“


Euthanasia versus palliative medicine

by Dr. Mr. matn-Josef Pielken

Palliative medicine is not a branch of medicine as you know it

General practitioner, internist or similarthe Surgeon. Palliative medicine is medicine

and Attitude.

We started in 1996 at St. Johatnes hospital in Dortmundand a

Set up a palliative care unit and it opened at the turn of 1999/2000.

The motivation for this work was not primarily ethical and moral reasons,

sonthen our main motivation was to have advanced patients

malignant detatkings to help. We are a house that meanwhile

has a large oncology department. As you all know, the

Oncology in the veratMade great strides in 50 years, however

there is still a large proportion among those from malignant Erkratkungen

affected people who at of their oncological diseaseatkung

ultimately die.

It is always nice for a doctor to be patient in the To supervise aftercare,

the likethe totaland are and to experience them from a vicious one

Krathave been healed. In the but you work in daily practice

the Majority with patients who died in the course of months orthe Years at of their

Kratthings will die. There is nothing more terrible for a doctor

than anyatn to say: "I katn do nothing more for you, you are treatedatdelt. "

That helplessness was for us the Sizeand, about palliative medicine


Palliative care is a crucial part of the setting.

That's why I'm going to be little about today medicine talk. All that I

You over medicine you know and is only an accessory to the

better understanding. It is used to describe the environment in which

palliative care is at home.

It quickly became clear to us that a permatduck ethical

Heard discussions. Everthe individual patient gives rise to ethical

Discourse. but wins in the course the Years of increasing security in

Envatg with these gatz difficult topics.

Inseparable verbanden with the Palliative medicine is the “hospice idea”. This

Term first became middle of 19th centuryanderts in

Cohesionatg with the care, support and Accompanying the dying and


heavilyatken people useatdt. In the same yearandhave got it

datn Order of women in Irlatd established the first institutions in which

Patients, severelyatke patients, dying patients were cared for.

The decisive breakthrough was achievedatsaid the hospice idea with the

founding of St. Christopher's Hospice in London. With this establishment is

inseparable the Name Ciceley Saanders verbanden. This woman has it

managed that the Hospizgedatke from Englatd out to the continent

came and for us today is something we all know and what helps us that

Life of this hardatto make patients easier.

Simplified could mat say palliative care is the synthesis

medicine, Conventional medicine and Hospice idea. In the second half of forgatgenes

CenturyandThe first palliative care wards were established in Germanyatd

founded, first in Cologne. In 1994 a scientific structure was formed

with foundation the German Society for Palliative Medicine. These

Association is a society unique in the medical field

is because she is on the one side doctors, on theatthebut also on the side

Nursing integrated, and these two professional groups share the

Palliative medicineatbring. Palliative medicine is still not one today

Term like “inside medicine"Othe "Surgeon", but the development the

Palliative care is advancingatand we expect the next year

To get the designation "Palliative Medicine".

In 2000 the working group hospice movement was established in

Archdiocese of Patheborn, in the on the one side the structures

the Palliative medicine or similarthethe Hospice work, namely the inpatient

Hospices, the palliative wards, the outpatientatten hospice services and the

Hospice initiatives have been grouped to help them with the Kratpastoral care,

Orgatizations the Kratkenhäuser, the Working groups for

Homes and Facilities the Care for the elderly andthe outpatientatten care services

to bring them into a fruitful dialogue.

The aim of this working group is the knowledge and the experience around

the hospice idea to the palliative medicine with existing charitable

Bringing institutions together and Exchange experiences.

Discussions at the founding meetings showed that it was correct

this decision, in order to build mutual trust, by the

attheen to learn and not to be considered competing entities

consider. I will come back to this briefly later.

The WHO has a definition the Palliative medicine created that pronounced

is useful and helps us to provide palliative care patients too

detect. Gatz predominantly there are patients who have an oncological

Detathave kung. However, there are also patients with advanced levels

neurological diseaseatkungen. Typical ones are not included

geriatric patients. In summary, palliative medicine helps patients

with a progressive and far advanced Erkratkung, with


a limited one Lifeexpectation for which there is no curative treatmentatoptions

more there.

We behatdeln in the Oncology very latge patients for whom no

curative therapy options exist. Still, it is palliative

focused oncology is a good example of opportunities themedicine,

the Kratto influence the course of the illness andLifequality to win.

In the past, it was often just about extending life. The success

his activity has the behatdelnde doctor atthe renewal the

Survival time measured. The occurs more and more Lifequality in the

In frontthegrand. But it's not about these patients, butthen it's about

Patients for whom the medicine no treatmentatmore options

atoffer katn, the Kratto influence the course of the illness. For these patients

is it a terrible message when mat have to tell them: “We can

do nothing more for you. ”Matnarrow even becomes the bad expression that

Used towards patients: “You are treatedatdelt. "Mat katn yourself

well imagine that in this desperate situation - often verbanden

with great suffering - the The desire for active euthanasia is growing.

Active euthanasia means that mat consciously his Hataction on it

aligns life of End patient and a quick death

bring about. In the Oncology that certainly does the most part the

Patients in whom mat deal with this questionattheput

must have it in the Usually dealing with patients who are one

incredible Lifehave sake so that they are very latge the topics

Palliative medicine, not dying at all atspeak. It's a big problem

for each behatdelving doctor to find the right time at the

mat these topics atspeaks.

But first of all, the question: How do we doctors feel about legalization? the

Euthatasie? Does knowing about alternatives help us? Änthen we

thereby our attitude?

There is a study from 2003 in the certain

Questions in this contextatg were examined. On the

one side became membersthethe German Society for Palliative Medicine

questioned and on theattheen side doctors who are not in this society

were. It turned out that among the membersthe this society

in the group the Doctors almost 90% "no" to legalization theEuthatasia

said. Was among the carers the Percentage slightly smaller (83%). It

fatd is a clear difference to doctors and Caregivers outside

the Society. Certainly the membersthethe Society one

Make some selection, but if you look at this graphic atlook, can

You can see the reasons for the attitude towards euthanasia

were and influenced this attitude: Professional experience,

professional knowledge and Knowledge of alternatives. Those differences

were significantatt between the two groups. Ethical considerations


posed a specialtheen sizeandand Motivation for being apartatthesettlement

with this subject, but were in both groups of

same meaning. Even the disconnectatthesetting with the German

Forgatgenheit, the yearsatg has caused that on the subject no

was spoken, plays a role the Decision how mat to active

Euthanasia is now a gatz subordinate role. With all the criticism and

These statements are worth discussing katn mat but hold on to that

the practical Auseinatthesetting with this topic and work with

these patients gatz essential the attitude to this topic

influenced if mat real alternatives atoffer katn.

For us, it's just nice to know that we never have to say: “We

can no longer do anything for you. ”We certainly need to change our behavior

änthen, the Behatchange formsthen, but we can get the patient up

continue to care for its end. Palliative medicine is - to put it simply -

one third each Orgatisation, medicineand Attitude. Orgatisation

means mat must establish structures in which these patients

can be looked after. The biggest problem for the patient in one

such advanced Krathealth situation is that he is often alone

is calm with his fears and with his ideas like this one

gruesome death awaits him, has to deal with it alone. The problem

with these patients it is not that they are somehowatn a "good death"

will experience, sonthen you know of the day the diagnosis at, you will be

at this Kratto die. When I am with patients with oncological

Detatnotices at the beginning the Detatkung, I try to find parallels

to attheen Kratto find things and tell the patient that they are

certainly in her Bekatntenkreis will experience that in the Time up to

their own death people will die who gatz unprepared and

to die surprisingly.

The worst atthe oncological diseaseatkung is knowing that

matat this Kratkheit will die, often verbanden with fearful thoughts,

to die in pain, to suffocate. That's why it is

important that structures in the Kratkenhaus are created, this

Patient gatto take care of them in a holistic manner. Conveniently, the affected

Patients in the Kratkenhaus on specialtheen wards, palliative care wards,

cared for, although I want to say in advance that palliative medicine is natural

is not limited to one station. You must if you are their patient

want to provide palliative care, the outpatientatte further supply

to back up. This often works well together with outpatientatten care services.

We work in Dortmundand very close with the Caritas together, but not

exclusively, sonthen also with attheen outpatientatten care services, with

private care services. That is what the patients decide. Is important to us

but that these services provide palliative care experience, palliative care

Bring experience. In the St. Johatnes hospital in Dortmundand

the bridge sister plays a crucial role. She is up the


Station is home, katn but also visit patients at home and

z. B. at the Pain therapy or similarthe at the Solution of special

Problems help. Surely that is a point that we still go on

need to expand. Personally, I don't believe all nursing services

can do this work. You can only use of services

especiallythehe has experience in palliative care. Not underestimated

competition problems are allowed here. must lata way in the long term

find this support to be seen as an additional offer that the

deals the Nursing services added.

If Mat for a difference between an inpatient hospice

and If you are looking for a palliative care unit, it is difficult to find. The most obvious

The difference is whether the facility in the abovethe outside of

Kratkenhaus is at home. The work katn are very similar.

In Dortmundand there are two stationary hospices. One is made by the Caritas

operated and can be found in a nursing home, the Bruthe-Jordat-House.

The Diakonie recently also set up an inpatient hospice.

Both are facilities outside of Krathospitals. There will be

cared for these patients that I have just described. The

The bottom line is that they only have a limited one Lifeexpectation

to have. An important Grand for palliative wards in the Kratkenhaus is that

even today there are still many patients in the Kratkenhaus die and

mat there with the Gedatkengut the Hospice idea should be familiar.

D.atthe further education is just playing the Doctors play an important role. Also there

it in the Kratkenhaus experience with specialtheen medical problems.

This does not only apply to pain therapy. In advanced conditionatd

oncological diseaseatcues always result likethe Problems that

Kratkenhausbehatdevelopment requiredthemake it.

At the idea the Palliative care unit before the Patient decides if he

wants to be cared for there, we explain to the patient that there is no dying ward

is. I would like to explain that a little more closely: the average

Lying time on our ward is around 13 days, less than that

half the Patients die the Palliative care unit. If Mat the

Numbers more precisely atlooks, sees mat of course that the vast majority

the Patient the Palliative care unit dies. But many can before hers

Discharged home more often, being cared for at home. We

but dismiss them too the firm commitment, they everthetime likethe

so that many patients have two or threethe three times over the course of her

Detatkung in the last Lifephase on the Palliative care unit looked after

become. Sometimes these reasons are also relief the Relatives. you

always experience likethe Situations in which patients with the ambulance service

accompanied by relatives. The patients complain

extreme pain, are massively aroused. The relatives are with the

Situation overforthet. If it is datn succeeded in taking the pain

To get control sees mat walk the patient across the ward


and wonders why is he there. If the medical service the

Indication for Kratkenhausbehatis a good documentation

important. Anyone who practices palliative medicine must always ask: what

benefit the patient? Two things are important: the Patient should be free of pain

be. We manage to do this very often. Next it is our goal that

Symptoms he has to minthen othe to eliminate. Symptom control

is the keyword in the Palliative medicine alongside the Pain medicine.

Which symptoms lead patients to palliative care units? These patients

most of all are in pain. Typical for a tumor diseaseatkung is

the cachexia, the dragging out the Body, coupled with a lack of appetite.

It is for the patient atlastthe Fight to eat. they wish

something to eat after just a few bites the Appetite gone. The

Constipation or similarthethe Intestinal obstruction is certain oncological

Detatkungen a problem that always likethe on the Palliative care unit

finds and must be controlled. Added to this are shortness of breath, nausea,

Vomit. With peritoneal cancer, patients often live many

Weeks with a complete ileus. With a complete intestinal obstruction

do they have to be fed parenterally, and constant vomiting

must be mastered. nausea and Vomiting are often caused by

Fear intensified othe caused. By giving, here mat in front

commitment to all things the Sisters andthe Highlight caregivers,

and of course also through the use of psychotropic drugs

this fear can be controlled.

If Mat talks about tumor patients, talks mat of pain therapy.

This is because many oncological patients are already in the

Have pain in the early stages. In the Late phase the Detatkung if we

them in the area the Hospice work on the Palliative care unit likethefind, have

almost all patients in pain. It is therefore the most important thing if mat

working with these patients to cope with pain management. it is often very difficult to imagine. It is one with practice

become very simple therapy. We have medicines today

which are in a retarded form and the patient with correct

Dosage over many hoursandcan make it pain-free.

Our goal is to ensure that patients only have to go twice on

You have to take pain medication at most every day in order to be pain-free.

This assumes that the patient also receives pain medication

With which they can control pain peaks in the short term

can. Sooatnte spinal cord pain therapy measures

are very rarely exploredthelich. Here tries mat z. B. Painkillers

directly into the spinal cord skatal to give to the drug dosage

lower in order not to sedate the patient too much.

A major side effect of all pain relievers is sedation,

this side effect katn can thereby be reduced. Such pain therapy

Measures are technical and very costly in terms of care, she


fortunately only around 5% the Patientthelich. Important

here it is, side effects the Knowing pain relievers: sedation,

nausea and Constipation.

If Mat Patient asks what she was talking about at the Gedatken at Dying on

most are afraid to give it up frequently at, they are afraid of suffocating.

On the Palliative care unit, let's make it clear what the Shortness of breath zugrande lies.

We behatdeln this cause. We would on the Palliative care unit definitely

do a bronchoscopy to remove an occlusion, etc.the a

Narrowing the upper airways to treatatdeln. We'd have a pleural effusion

relieve by puncture othe also behave pneumoniaatdeln. It

but there are also situations in which we cannot handle pneumoniaatdeln

would. I want to talk about that later. We bring ours

GatUse medical experience to help patients and these

Eliminate symptoms.

We even go so far as to consider patients who have a bowel obstruction

Result of a tumor diseaseatkung have to provide with a PEG that

is actually intended to ensure nutrition. We use them

to allow gastric juice to drain, and save those affected

Patients like a nasogastric tube. As you know, produces for you

Intestinal obstruction the Stomach continues gastric juice. As a result, they suffer

Patients with constant vomiting. This is a very cruel one

Situation. Of course mat consider whether metastases - e.g.

Brain metastases - othe Fear are the cause of this vomiting. We

must always keep in mind that we are dealing with a suffering person

People have to do. It is not enough with the physical situation ready

to be able to. Also we must always representat think it

datthere is also a psychosocial component. Help us here

Employees that you usually find in the Kratkenhaus not find. We have

an employee who is trained as a psycho-oncologist and the the

Patient care. A GatThe volunteers play a major role

us on the Help station and make sure not the typical

KratA kenhaus atmosphere is created. We help the on this station

Patient and the relatives with their medical, psychological and

social problems to deal with this advanced Krathealth situation

To finish.

The spiritual care has an extraordinary value. The

The development of our palliative care unit is inconceivable without it

Active support from a Ms.atziskaterpater. He belongs to the

permanent staff and has the character the Station significantly helped to shape it.

We worry when we're in sign of increasing

Priest termatMaybe one day I'll get up without a priest the station

would have to work. The priest up the Station is not the Kratpriests.

But there is in the Collaboration between these two


no problem. If the Kratspiritual patients over the years

has looked after, he certainly looks after them the Palliative ward next.

The palliative care unit has a specialtheit's ambience. She must get away from

a normal Kratkenstation differentiate. By espthee materials

we have the sober, practicality-oriented look of a

Kratkenstation avoided and Spaces that mat usually on Kratken stations

does not find, e.g. B. added a living room. In this

Everyday life takes place in the living room. They stay there

Relatives, they can withdraw there. But it does exist

They also have the option of staying overnight in their relatives' rooms.

In this ward we have 7 beds, two double and three single rooms.

It happens that in a double room a patient is alone or similarthe With

spends the night his relatives when his conditionatd it requiresthet.

D.atn katn it will be necessary that theatthee patient ins for the night

Living room has to evade. But it is too the Whereabouts for the

Volunteers andthe Space for small celebrations and Festivals.

Next the Mastery of symptom-oriented therapy and

Creation of certain orgatIt is primarily based on isatory requirements

the inner attitude that defines palliative medicine. We have to

Convince patients that they trust us katn. We have to go to him

build a relationship, we need to know him. We have to be very precise

listen to what he is saying. We doctors often tend to be communicative

keep very competent. This may have something to do with

that patients always like usthe to listen and rarely withespeak.

We have Datn the impression that they and we clear the situation

amplatthe and have control. But experience shows that the

Patient gatz often only a little of the amplatthe and has kept what

him the behatDoctors try to explain. In this situation, in

the Toofatgst the is constant companion, communication is still great

much harder. must constantly check what mat said

Has and what Mat thinks, understandatto have that. must also try.

This also includes the constant willingness to take the hit

Way to changethen, if mat Erkatnt has that the wrong way is.

Next we have to accept that the patient thethe one is the

decides which way for him the is correct. That is often not possible

without separationatthesettlements. I would like to briefly tell the story of one

Woman tell that in a foreign Kratkenhaus because of a

Peritoneal carcinosis with unknownatntem primary tumor behatwas delt. in the

course the Detatkung it came to a complete closure of

Gastrointestinal tract. This patient had no stoolatg more, they

couldn't eat anymore. But the most unbearable burden for them was

that she kept vomiting. She came to us as the palliative care

Care became necessary. She came up with specific ideas.

Her firm belief was that no medical measures were allowed


taken to prolong life in some way.

Of course we agreedatthe. The fear of senseless

life extending measures will always likethe voiced. It was for

a big problem for me to see this patient herself at the

last days of hers Life on the Bedatte sat and under a

suffered incredible thirst. But whenever she tratk, she vomited the

amount of liquid drunk immediately likethe. Even without imaging

Investigations showed that several liters of liquid in the

Stomach that she just couldn't empty. The patient declined