Medical legal and ethical questions in palliative medicine and euthanasia.

The increasing importance of legal and ethical questions in palliative medicine and euthanasia due to the increased technical possibilities for extending life will be considered. In palliative medicine, the choice of the best therapy will be discussed, especially in the case of oncological diseases. Here, consideration of the prospects of success, for example, in chemotherapy, is faced with partly serious side-effects. The requirements of palliative medicine that the patient has to be fully informed of the fatal prognosis of his disease is equally debated as the optimum pain therapy. In this respect, the modification of the Narcotics Act of 1 February 1993 is also under discussion. In the field of euthanasia, the technical development of life extension versus dying has raised considerable legal and ethical problems regarding termination of therapy. Additionally, fiscal considerations are of increasing relevance. The common development of the legal and ethical discussion, for example, with regard to the publicity of the work of the so-called 'Gesellschaft für humanes Sterben', the public discussion leading up to a hearing of the 'Bundestag' regarding active euthanasia leads to a realization of the subject. The proposals for an active termination of life by discontinuing therapy for adults and also for malformed newborns are discussed. A dispute concerning the new legal regulation of active euthanasia in the Netherlands of February 1993 is also discussed. There, around 2% of all deaths per year result from active termination of life and also cases where persons are not able to consent. This also has enormous consequences for the position of the physician.(ABSTRACT TRUNCATED AT 250 WORDS)

[Suicide in pregnancy]. / Suizid während der Schwangerschaft.

The difficulty in establishing the cause of death of a pregnant woman emphasizes the necessity for the careful gathering of evidence. Especially in the case of motor accidents along lonely stretches of road involving a solitary motorist the possibility of suicide should be taken into consideration. Since a televised suicide had apparently served as model for the method of suicide, mention has been made of the "Werther effect". A literature review reveals that little has been written on the subject-suicide during pregnancy.

[Unusual suicide caused by a stab wound in the neck]. / Ungewöhnlicher Suicid durch Stich in den Nacken.

A case is reported of a man with a deep nape stabwound completely severing the medulla of the spine. A strangely formed bottle neck fragment is the assumed weapon. Further investigations allow a scene reconstruktion, police inquiries throw light on a previous acute psychotic disorder of the suicide.

[An unusual death in water]. / Ungewöhnlicher Tod im Wasser.

A case of combined suicide involving the explosion of a handgranate in water demonstrates the possible misinterpretation of external injuries.

[The Duffy system: a population genetics study in Portugal, Guinea-Bissau and Brazil]. / Das Duffy-System: Eine populationsgenetische Untersuchung in Portugal, Guinea-Bissau und Brasilien.

2225 blood samples from Portugal (classed according to historical provinces), 301 blood samples from Guinea-Bissau (classed in tribes) and 697 blood samples from Brazil (classed according to colour of skin) have been tested in the Duffy system. The Portuguese seem to be a sufficiently uniform and autonomous population. This is also true for the (non-rejected) blood-samples from Guinea-Bissau. The Brazilians differ in accordance with their colour of skin. The expected relations between Portugal and its former colonies can be proved. The Duffy system is suited for the distinction of black and non-black populations and enables to recognize extraneous admixtures.

[Suicide by intravenous injection of sublimate solution]. / Suizid durch intravenöse Injektion von Sublimatlösung.

A 19-year-old drug-dependent man tried to commit suicide by intravenous self-injection of 5 ml concentrated mercury II chloride solution. He arrived at an intensive-care unit 2 h later with predominantly gastrointestinal symptoms and died 70 h later, despite hemodialysis and antidote therapy. The pathologic-anatomical picture was dominated by severe acute sublimate nephrosis and a coagulation disorder. The highest Hg content was found in the kidneys (5.69 mg%); in the gastrointestinal tract the Hg concentration lay between 1.12 and 3.26 mg%.

[Effect of metoprolol on the elimination kinetics of ethanol]. / Einfluss von Metoprolol auf die Eliminationskinetik von Athanol.

Eight healthy probands received 1.0 to 1.3 g ethanol per kg body weight within a period of 30 minutes. The average hourly elimination rate of ethanol during the postresorptive phase was found to be 0.18 g/l. No significant increase in the elimination rate was seen either after administration of 200 mg metoprolol per day in slow release form for a period of one week, or after a single dose of 200 mg metoprolol in standard formulation taken at the beginning of ethanol ingestion. On the other hand, long-term administration of metoprolol resulted in a steeper rise and a delayed decrease of blood alcohol concentration. Simultaneous intake of metoprolol and of alcohol in high dosage should be avoided.

[Comparative studies on properdin factor B (Bf) polymorphism in random samples from Brazil, Germany and Guinea-Bissau]. / Vergleichende Untersuchungen über den Properdin-Faktor B (Bf)-Polymorphismus an Stichproben aus Brasilien, Deutschland und Guinea-Bissau.

Three different population samples have been tested for properdin factor B markers: 395 individuals from Schleswig-Holstein (Germany), 343 individuals (Europids) from Southern Brazil, and 309 individuals (Negroids) from Guinea-Bissau (Western Africa). These samples are showing marked differences in the distribution of Bf gene frequencies. As for the sample from Southern Brazil the Bf data are confirming the assumption that the Caucasoid population in Southern Brazil is somewhat mixed with Negroids.

[Epidemiology of sudden infant death (sudden infant death syndrome, SIDS) in the Lübeck area. Catamnestic studies of 155 observed cases from 1971 to 1981]. / Zur Epidemiologie des plötzlichen Säuglingstodes (Sudden Infant Death Syndrome, SIDS) im Lübecker Raum.

The 155 cases of SIDS investigated at the Institut für Rechtsmedizin of the Medizinische Hochschule in Lübeck (northern part of the Federal Republic of Germany) between 1971 and 1981 have been analysed retrospectively under epidemiological aspects. The incidence was 2.17 cases of SIDS/1,000 live-born babies, 63.9% were male, 79.3% of the infants died during the first 6 months of life with a clear peak in the 2nd month. There was no seasonal accumulation; 68.4% of the infants died between 8.00 p.m. and 8.00 a.m., in 75% the socio-economic factors were inconspicuous, but we observed a significantly higher incidence of infants from mothers younger than 25 years. In 58% of our cases no signs of illness or changed behaviour had been observed during the 48 h before death. The results of our study are compared with the literature and discussed with special regard to a possible prevention.

[Early recognition of hypoxic lesions in the cerebellum using Lie staining (HBFP staining)]. / Untersuchungen über die frühzeitige Erkennbarkeit von Hypoxieschäden am Kleinhirn mit Hilfe der Färbung nach Lie (HBFP-Färbung).

Using the Purkinje cells of the cerebellum from 42 rapidly and 28 slowly dying patients, we tried to find a correlation between the premortal hypoxie in brain and the result of HBFP staining. We found four different stages of staining and discuss here the causes of staining and false results.