Artikel
Palliative medicine – current developments in health politics
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Veröffentlicht: | 20. März 2006 |
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Gliederung
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At first sight, the recent dynamic development of palliative medicine in Germany has been impressive: In the period from 1996 to the end of 2005 the number of palliative care units (PCU) increased from 24 to 114 and the number of hospices from 31 to 129. In 2003, the German Medical Association passed amendments to the model post-graduate training regulations and, in tandem, continuing medical education regulations – in the field of palliative care. Furthermore, it stated that further training for all patient-centred medical specialties must include the essentials of palliative medicine. The study commission ‘Ethics and Law in Modern Medicine’ of the German Bundestag submitted their report on the state-of-art of palliative care and hospice work, including recommendations for improvement. According to the coalition treaty of the German government, the further development of palliative care is one of the declared goals of health politics. It would be a false conclusion to believe that this generally impressive development in Germany means we have reached our goals in palliative care and hospice work. In fact, quite the opposite is true: in terms of its establishment and implementation, we are only just getting off the ground in many areas of palliative care. For example, the new qualification requirements for physicians do not yet include palliative medicine as a compulsory subject of the teaching and examination syllabus. Compared with the internationally approved estimated standard need of about 50 beds in PCU and hospices per 1 mill. inhabitants, the current German ratio of 10 beds in PCU plus 15 in hospices per 1 mill. inhabitants covers no more than half of the need. Inpatient palliative care services are by no means sufficient, nor are they available in all areas. Furthermore, the supply of these services shows substantial regional differences. The undersupply of specialised palliative care services in the outpatient sector is far worse than the deficiencies in the inpatient sector. About 320 such services are needed for German-wide coverage. Currently, no more than about 60 home care services are available. Instead of continuing the debate on the legalisation of euthanasia in Germany, we need an immediate and forceful promotion of palliative medicine, aiming at its implementation in all fields of care and education and the availability of its services in all areas. The recommendations of the study commission should be taken seriously and put into practice.