Ethische Entscheidungsfindung im Rettungsdienst
摘要
Out-of-hospital emergency medicine is characterized by time pressure, limited patient information, and emotionally charged situations. Despite these challenges, ethically sound decision-making is not only possible but essential in the prehospital setting. This position paper outlines that treatment limitations, forgoing patient transport to a hospital, and palliative goals can be ethically justified and are necessary parts of emergency care. Prehospital emergency medicine is based on the ethical “two-pillar model” of medical indication and informed patient consent. Assessing decision-making capacity—especially in the context of treatment refusal or forgoing transport—requires a structured approach. Relevant legal frameworks, including advance directives, health care proxies, and the German Paramedics Act (NotSanG) are discussed. Specific challenges arise in cases involving psychiatric illnesses, cardiopulmonary resuscitation, and patients with advanced incurable conditions. This paper advocates for greater ethical awareness in prehospital emergency medicine and increased competence among emergency physicians. It also emphasizes the need for adequate ethical decision-making. Its goal is to strengthen clinical confidence in navigating between what is medically possible and what is achievable with respect to the patients’ autonomy—even under challenging conditions of prehospital emergency care.