Materials

Issue 125: Spittler, Johann F.: Locked-in-Syndrom und Bewusstsein - in dubio pro vita. August 2000

The course of a basilar thrombosis is presented, that led into a locked in syndrome. Ability to open and dose the eyes upon request was preserved, but no meaningful communication about ,no' or 'yes' was reached. Incomplete, typical and total locked-in syndromes are con sidered in relation to conscious awareness. Extubation on trial resulted in distressing and insufficient breathing, so we decided to intubate and ventilate again. The conflict between the demand for an immediately relieving intubation and a forseeable, long-lasting, and torturing course constitutes an inevitable ethical dilemma. Difflcult moral dilemmas in medicine may be decided on the morally safe side: ,in dubio pro vita'. However, medicine up to now has reached therapeutical feasibilities, the consequences of which may lead to long-lasting suffering. Since, for the patient, there is no way to escape these consequences, physicians haue to consider prolonging life against prolonging suffering carefully. The latter consequence must not be removed from our awareness into nursing homes. Difficult moral decisions in medicine are characterised by the contribution of implicit, often psychological reasons and motivations. In every single case these implicit multidimensional valuations have to be disclosed and decided deliberately. Medical ethics must not only debate logic and aesthetics of systematic value concepts, but haue to teach physicians to conciliate the complex value concepts of our patients and their relatives.