When treatment no longer reaches its goal

When the goal changes

An intensive care measure is permissible when two things apply: it is medically indicated, and it corresponds to the patient’s will. If one of the two falls away, the goal of treatment changes.

That is not an end of treatment. It is a different treatment. The goal is then no longer to extend life, but to take away symptoms.

Responsibility for that decision lies with the treating doctor, in the sense of the patient. It does not lie with you. You are asked what he would have wanted.

What I do in this phase

• I examine what the current treatment is meant to achieve and whether it can achieve it.
• I establish whether there is an advance directive, a health care proxy or a guardianship, and whether it fits the situation. You take part in that.
• Where it fits, I propose a time-limited trial of therapy: a defined goal, a defined period, defined criteria and a defined date on which the decision is taken again.
• I tell you that a clinical ethics consultation can be requested by you as well, not only by the treating team.
• I write down what was discussed and give it to you.
• I speak with the treating team, not against it.

When transport no longer makes sense

There is a point beyond which a flight gives the patient nothing and burdens him. And there is another point at which a flight remains right although he will probably not survive it.

Those are two different questions. I answer them separately, and I answer them beforehand.

My fee does not depend on whether a flight takes place.

If there is a flight, I record in writing beforehand what applies should he die on the way: who decides then, where the aircraft lands, who issues the papers.

When he dies

Then my medical task ends, but not on the same day.

• I explain what the papers say: the death certificate, the civil death record, the laissez-passer for a corpse. I tell you whether they are complete.
• I tell you which decision depends on a deadline. In some countries the choice between burial on site and repatriation falls within hours, not days.
• I tell you who does the rest. The German mission abroad issues papers and certifies them. It organises nothing and it pays nothing.
• I do not organise repatriation, I do not recommend an undertaker, and I take money from none of them.

After four to six weeks I offer you a conversation. In order to go through the course again, because by then the questions have changed. You do not have to accept.

What this is not

• This is not bereavement support. I am not trained for that.
• This is not palliative care. That is provided by whoever is on site.
• This is not an assessment of the doctors who treated him.
• And I tell you nothing I cannot substantiate.