BACKGROUND:The legal framework for fluid management in the palliative care setting varies between continents and even between countries. OBJECTIVES:What legal implications must be taken into account in Germany in dealing with "terminal" dehydration? MATERIALS AND METHODS:Relevant publications in English and German have been identified. Notably, German recommendations and guidelines were reviewed, whereas national mindsets were contrasted with those of other countries like the United Kingdom and Canada. RESULTS:Our legal considerations are in line with the recommendations of the German Federal Medical Association. Key components are "patient autonomy", "best possible symptom control" and a "steady therapeutic risk-benefit assessment". Dehydration should then continue to be regarded as a "symptom" that must be "controlled" as long as it can be improved by therapeutic means and as long as the patient is not opposed to this approach. However, if dehydration remains therapeutically refractory, it is justified either not to initiate clinically assisted hydration (CAH) or to stop the ongoing therapy. The "shared decision-making model" practiced in Canada is diametrically opposed to this approach, where paternalistic decision-making is possible, provided that patients or relatives appear to be ill-informed and unprepared to decide "correct" according to expert opinion. CONCLUSIONS:A "non-refractory" state of dehydration at the end of life must not be left untreated under German law and must not be used as an option to hasten the death process if the development of dehydration does not correspond to the patient's will or if this will cannot be determined.

译文

背景:在姑息治疗环境中进行液体管理的法律框架在各大洲之间,甚至在国家之间也有所不同。
目标:在德国处理“终端”脱水时必须考虑哪些法律含义?
材料与方法:已经确定了英文和德文的相关出版物。值得注意的是,对德国的建议和指南进行了审查,而将国家的思维方式与英国和加拿大等其他国家的思维方式进行了对比。
结果:我们的法律考虑符合德国联邦医学协会的建议。关键组成部分是“患者自主权”,“最佳可能的症状控制”和“稳定的治疗风险效益评估”。脱水应继续被视为“症状”,只要可以通过治疗手段加以改善并且只要患者不反对这种方法,就必须加以“控制”。但是,如果脱水仍在治疗上难以治疗,则有理由不启动临床辅助水合作用(CAH)或停止正在进行的治疗。在加拿大实行的“共同决策模型”与这种方法截然相反,这种方法可以实行家长式决策,但前提是患者或亲属似乎不了解情况并且不准备根据专家意见做出“正确”的决定。
结论:根据德国法律,生命终了的“非难治性”脱水状态必须保持不变,并且如果脱水的发展与患者的意愿或意愿不符,则不得将其用作加速死亡过程的选择。如果无法确定。

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