Zur Verantwortung des Arztes

What do we mean by the frequently invoked yet seldom questioned "physician's responsibilty"? This study, which was awarded the Stehr-Boldt Prize by the University of Zurich, attempts to define this more closely for the physician in his real work as part of the diagnostic-therapeutic process. Why has the term "physician's responsibility" replaced the traditional term "physician's obligations"? Is the physician primarily responsible for his patient or even for the health of the entire population? What responsibility is a result of the constitutive precariousness of the medical profession, in which there is no guarantee of success or of the absence of undesirable side effects? Is it possible to obtain guidance in dealing with controversial issues such as abortion or euthanasia by examining the physician's responsibility? SummaryWhich responsibility can in a sensible way be ascribed to a physician? In order to settle this question I start by investigating the epistemological status of medicine and the role of the physician. Medicine can best be described as a practical science whose consequences for a theory of action have a lasting influence on the physician s responsibility. Falling back upon the philosophical discussion on the term responsibility in the 20th century, I will show that responsibility without normative criteria remains a hollow phrase. Because traditional values are given in medicine and are furthermore well-founded, and because the physician s work bears just the mark of complexity that among other things 'called for responsibility', the term 'responsibility' is very well suitable to investigate the physician s work. As a term bearing at least six different realtions, 'responsibilty' allows a differentiated analysis of the physician s action with its different levels and addresses. Due to the immanent structures of his action the physician is responsible for certain, precisely to be phrased ways of behaviour, for working according to the rules of the medical profession and for a disposition. None of these levels can be done without as they do not replace one another. The following chapters examine the boundaries of the physician s responsibility. Even with reference to history the physician should in cases of conflict above all be responsible to his patient. Cases of conflict should be avoided in the following manner: If a certain kind of behaviour in the relationship between physician and patient cannot be allowed due to social considerations this should be decided beforehand by the authority in charge, and these questions should just not fall in the physician s realm of consideration. In questions of allocation it is true that a responsibility for rationalization has to be ascribed to the physician, but under no circumstances should he be in charge of rationing as this would exceed the unifying quality of the various responsibilities and have an extremely disadvantageous effect on the relationship between physician and patient. Explosive subjects such as abortion or euthanasia can also not be settled by way of the physician s responsibility.