[Individual treatment access and its limits with reference to costs]. / Individueller Behandlungsanspruch und seine Grenzen unter dem Kostenaspekt.

The precept of economic efficiency (Wirtschaftlichkeitsgebot) in section 12 SGB V does not concern the aim of the treatment, i.e. it does not mean that the treatment of certain illnesses should be rationed but that the aim of the treatment should be reached with the least possible expenditure involved. Reductions in the budget and control methods according to the average practice do not affect the claim to treatment according to the medical standard. In case of advancing rationing of medical service the rules concerning the conflict of duties will have to be applied.

[Medical confidentiality towards health insurance, employment, state offices and health insurance companies--legal guidelines]. / Die ärztliche Schweigepflicht gegenüber Krankenkassen, Arbeitgebern, Behörden und Versicherungsgesellschaften--rechtliche Uberlegungen.

The relationship between physician and patient has become multi-dimensional due to the inclusion of state offices, health insurance companies and other insurance companies. Thus, the medical confidentiality has been compromised, inevitably information will be spread into a wider circle. Nevertheless, the principle of confidentiality should be upheld.

[Revision of the medical malpractice law--legal aspects]. / Novellierung des Arztstrafrechts--Juristische Gründe.

Since the beginning of this century, modifications of the criminal law regarding medicine have been outlined frequently. The focus of these modifications was to eliminate the circumstance that each medical procedure is a criminal offense even if it was performed correctly and was successful. Treatment without consent was supposed to be punished. The draft recently submitted to the ministry of justice seems to be a failure. The prerequisites of an effective consent remain unclear. An incorrect information of the patient would be classified as intent and, thus, be punishable. By application of uncertain criteria, medical experiments and treatment procedures might be followed by excessive punishment.

[Education responsibility, specialty and administration information from the legal viewpoint]. / Aufklärungspflicht, Fach- und Gebrauchsinformationen aus juristischer Sicht.

The producer and the distributor of medicines as well as the physician are obliged to inform the patient about risks and side effects of medicines prior to use. The pharmaceutic producer must inform the physician through respective data sheets and the patient through leaflets inserted in the packages. The value of the latter are doubtful and not always useful. In any case written informations are not sufficient. The physician after clearing up the individual situation has to orally inform the patient taking his intellectual level into account.

[Medical expert assessment in psychiatry from the legal viewpoint]. / Arztliche Begutachtung in der Psychiatrie aus juristischer Sicht.

The subjects of psychiatric assessments do vary greatly. The main subject of criminal proceedings seems to be that of criminal responsibility. This leads to many misunderstandings. Court and expert have to use the same definitions. Criminal responsibility cannot be the deterministically interpreted freedom of will. The prevailing law does only answer insufficiently the question of selection or consultation of further experts.

[Limits of patient responsibility for cooperation with medical experts]. / Grenzen der Mitwirkenspflicht des Patienten beim Sachverständigen.

The accused, the parties and the witnesses have different far-reaching duties of cooperation in the different proceedings. This will be investigated in the following paper. The most differentiated regulations can be found in criminal proceedings. The principle of reasonableness forms a limit but is difficult to put in concrete terms.

[The standard of required medical responsibility as an instrument in malpractice cases]. / Der Standard der erforderlichen Sorgfalt als Haftungsinstrument.

This article is about the meaning of "standards" in medical treatment. We want to work out especially the function of "standard" as an instrument of legal requirements in medical responsibility, the forming of "standard" with real or normative criterias as well as the guidelines to the right use of standard by the judgement of medical care: 1. The "standard of necessary medical care" is a need but not a totally binding instrument to determine the required medical treatment. It marks special rules that are generally accepted by knowledge of science and practise. 2. "Standard" does not determine a special method for now and forever. It is variable and leaves space for other new methods whose expected success is not unproportional to the risks. The danger of standardization can be the establishing of backwards directed previous methods. 3. A fundamental instrument of establishing "standard" as a judicial criteria are the medical experts. They have the difficult role of mediator between medical methods and judicial responsibility according to the standard of necessary medical care.

[Organ transplantation, development and perspectives of the legal status]. / Organtransplantation, Entwicklung und Perspektiven der juristischen Situation.

The FRG has no transplantation law as most other European countries do. A model of agreement is practised which is derived from fundamental principles, i.e., a personal right outlasting death and the agreement of the next of kin for organ removal. The paper favours a legal regulation that resolves the difference between a model of presumed consent on the hand and a model of agreement on the other hand, and advocates informing the next of kin, who can then object as representatives of the deceased.

Simple disturbance of the dam in the neonatal period can alter haloperidol-induced catalepsy in the adult offspring.

Three experiments were performed to determine whether apparently minimal disturbances of dams and litters would influence haloperidol-induced akinesia. In Experiment I, Long-Evans hooded rats (a) were left unmanipulated, (b) received nestcage relocation and observation, (c) received nestcage relocation/observation and maternal separation, or (d) received nestcage relocation/observation and pup handling. The male adult offspring received open-field testing and later received forepaw-on-dowel catalepsy testing following saline, morphine (20 mg/kg), or haloperidol (2 mg/kg). In Experiment II, hooded rats received (a) no manipulation, (b) nestcage relocation, (c) maternal separation, or (d) pup handling. At weaning, dams were tested in the open-field. Activity wheel locomotion of the offspring was assessed following saline or haloperidol for 3 days/week for 3 weeks; then, 5 and 7 days later, rats received haloperidol (0.5 mg/kg) and catalepsy testing. In both experiments, manipulations involving the dam reduced the offsprings' haloperidol-induced catalepsy, but, in Experiment II, a history of haloperidol administration distinguished between the effects of nestcage relocation and maternal separation. In Experiment III, Swiss albino mice received (a) no treatment, (b) nestcage relocation and maternal separation, (c) relocation/separation and mild cold stress of pups, (d) relocation/separation and pup handling, or (e) relocation/separation and severe cold stress of pups. Adult male mice received saline or haloperidol (2.5 mg/kg) and inclined grid catalepsy testing. Mice receiving relocation/separation and mice receiving relocation/separation and severe cold stress showed enhanced catalepsy versus control mice. Thus, it was concluded that seemingly innocuous events in infancy can influence the intensity of extrapyramidal side effects of neuroleptics in adulthood.

Social factors influence haloperidol-induced catalepsy in rat.

This study employed manipulations which presumably influence social interactions in rats: (1) paired housing with a heavier conspecific and (2) exposure to the odors of other rats. The dependent variable was the akinetic state induced by haloperidol, a neuroleptic and dopamine antagonist. In Experiment 1, adult male Long-Evans hooded rats were matched by weight and caged alone or in pairs with one rat 30 g heavier than its cagemate. All rats received haloperidol (1.5 mg/kg) and catalepsy testing. Heavy rats showed more catalepsy than the lighter member of pairs or weight-matched, singly housed controls. In Experiment 2, adult male rats were left unrecaged or were recaged into cages with bedding recently soiled by females or other adult males. After haloperidol (1.0 mg/kg), the rats exposed to bedding soiled by other adult males showed more catalepsy than did the control groups. Thus, the results of both experiments indicated that social factors can influence the akinesia induced by dopamine antagonists.

[Truth at bedside in relation to poor prognosis. Legal aspects]. / Die Wahrheit am Krankenbett bei infauster Prognose. Juristische Aspekte.

Adjudicary decisions dating from the past have demanded unqualified enlightenment of the patient about his illness. Physicians could disregard this requirement only if there was a danger that this policy might result in severe, irreversible and permanent damage. This interpretation seems too narrow. The physician must carefully weigh what he can and must demand of the patient, depending on the personal situation. Neither rigorous truth at any cost nor the principle of concealment of the hopelessness for the patient's condition is correct. Telling the patient the truth "costs" the physician personal involvement, explanation and human assistance.