+++ 22. Januar 2010 +++
Debate on Rationing Medical Care Relaunched in Germany
The Frankfurter Allgemeine Zeitung featured calls for the triage of care to patients, in its Sunday, Jan. 17 edition. Health economist Friedrich Breyer of the University of Constance is quoted saying that "the discussion about rationing in the health system has to be conducted now," because economic growth is on the decline and people are living longer. "We are no longer able to finance the increase in medical knowledge and expenses with a growing economy," he argued. And Christiane Woopen, a Cologne-based medical ethics expert and member of the government ethics council, lamented that it "is taboo in Germany [to discuss] which illnesses are to be treated and with what priority."
As for the president of the German Medical Association, Jörg-Dietrich Hoppe, he indicated that "clandestine rationing" is already being done in German hospitals under the impact of budget restraints. In many hospitals, he said, cancer patients, for example, do not get the appropriate cancer therapy, but the inexpensive therapy. While the burden of decision-making now lies with the medical staff, Hoppe treaded into dangerous territory by proposing that politicians, rather than professionals, define the criteria for which treatments and patients should have priority.
This has kicked off an intense public debate in Germany. Birgit Fischer, the director of the health insurer Barmer Ersatzkasse denounced Hoppe's charges, on Jan. 19, on ARD TV, saying that he was arguing from a "medical ethic" viewpoint and was spreading panic among the insured citizens. Current practice, she said, is to find the kind of treatment that "precisely fits" the individual patient. However, as she added that "research on treatments" was required to "make truly individual treatments possible," which would then lower expenses, her arguments indeed seemed to go into the direction of rationing.
Note that a new book has been published on Karl Brandt, one of the masterminds behind the infamous T-4 euthanasia program of the Nazis. Brandt was among the seven Nazi doctors convicted and sentenced to death by the U.S. at Nuremberg, including specifically on charges of euthanasia.
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