[The surgeon between bureaucracy and the law].
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Biomedical subjects
Publications and source records attributed to W Weissauer.
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The patient has a claim to treatment commensurate with the standard of an experienced specialist. He who performs a service in which he is incompetent or no longer competent increases the risk of the treatment and at the same time exposes himself to the accusation of criminal responsibility. The systematic provision of continued education and advance training is essential to guarantee professional qualifications. This also includes the requisite organization (procedural quality) and the provision of appropriate personnel, equipment and premises (structural quality) at the place of surgery.
The agreements between surgery/anesthesiology (1970) differentiate between specialist and indisciplinary intensive care units. In the specialist unit the surgeon is also responsible for intensive care therapy. In the interdisciplinary units the surgeon is responsible for the treatment of the primary disease and the anesthesiologist is responsible for the intensive care therapy. Their cooperation is determined by a strict division of labor and the principle of confidence. The agreements, which have proven successful legally, leave the decision about a more detailed delimitation of the tasks to local arrangements. It is suggested that a concretization of the agreements of 1970 should perhaps be considered.
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The homologous blood transfusion bears some risks (infections, intolerance reactions) which cannot be controlled even if all requirements of medical diligence are met. The risk of an AIDS infection is much less important than that of hepatitis non A non B. However, this new disease is the reason that physicians, patients, as well as the public have become particularly aware of these risks. Among other measures of risk minimization by blood sparing procedures, the possibilities of autologous versus homologous transfusions have to be discussed, too. The autologous transfusion offers more security. From the legal point of view, the physician has to choose the less dangerous of two equally efficient methods as soon as this method is available for practical use. The donation of autoblood which has a limited range of application (elective interventions) is a recognized method, but its general realization is still hindered by unsolved problems of pharmacology law, organization and remuneration politics. The preparation of autoblood from intraoperative losses of blood is not yet possible at all department because of the high equipment costs and the personnel expenditure. The hospital institution is in charge of providing the equipment and the staff necessary for a medical care which meets the modern standard. The chief physicians have to inform the hospital institution about these requirements. If autologous transfusion procedures are practically not available, it depends on regional conditions if an information of the patient is obligatory or not.
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The objects, aims and methods of research are protected from political misappropriation. But the freedom of research is limited by the clash with the legally protected third party, especially in the law of integrity of life and limb. To protect the environment from the (hypothetical) epidemiological dangers of gene technology the legislator has limited himself to measures by which he can obtain this aim with the least infringement of freedom of research. Gene technological intervention in human idioplasm is apparently not yet serious. Nevertheless the ethical and legal problems which arise form the point of view of human dignity from experiment with human genetic material should be discussed now.
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