[Pain therapy--legal reference points and stumbling blocks]. / Schmerztherapie--rechtliche Eckpunkte und Stolpersteine.

Pain therapy and palliative medicine have gained new importance in medical treatment in recent years. Pain is no longer considered an acceptable evil; in fact, awareness has increased that even in tumor patients and those with chronic pain the available options for special pain therapy can provide long-term pain relief. Pain therapy is not limited to these fields but applies to all areas of medicine. Unfortunately though, pain therapy has become the focus of forensic considerations, illustrated by the current case of an internist in Hannover who has to answer for eight counts of manslaughter this year. She is charged with ordering inappropriately high doses of morphine and in part excessive administration of diazepam. Legal practice shows however that the predominant number of preliminary criminal proceedings and civil liability lawsuits do not involve pain specialists and palliative physicians, but rather other specialties such as the surgical disciplines and patient care. This is not surprising since good pain therapy is at present expected in all branches of medicine but obviously those fields not specialized in this subject lag further behind in these expectations than those already dedicated to pain therapy or palliative medicine.

[On informed patient consent]. / Patientenaufklärung--Fakt und Fiktion.

One third of all lawsuits against doctors include statements of insufficient or lacking informed consent. The objectives of this prospective study in 104 patients were to elucidate the actual clinical routine of obtaining informed consent (process quality), collect information on active and passive recall 3 to 7 days p.op., and to investigate whether patient age, sex, education, profession, and cognitive function using the Mini Mental State Test, the time from obtaining consent to interview, acuity (emergency vs elective cases), and quantity of patient/doctor interaction would influence the patient's recall capabilities. In clinical routine, obtaining informed consent is a very variable procedure, and between two and 18 items were documented by the physician. Of the patients, 12.6% recalled actively and 43.5% passively. They named between 1.1 and 3.7 items on average, with "infection" as the leading complication, followed by "pain" and "lesion of nerves". Of all parameters investigated, only the number of initially documented items exhibit a significant effect on the patients' recall. The quantity of patient/physician interaction not only guarantees an increased effect on recall but also means improves patient interaction, thereby reducing the probability of imminent accusations.

[Legal particulars in treatment of minor patients]. / Rechtliche Besonderheiten bei der Behandlung minderjähriger Patienten.

According to current jurisdiction any intervention of the physical integrity of the body, even medical treatment and the administration of medication, constitutes a physical injury. The legal authority for this primarily comes from the consent of the patient. The problem for the medical doctor is whose consent is necessary when a patient is a minor. According to the jurisdiction and the literature, the consent of a minor to medical treatment is a legally binding decision not dependent on reaching the age of majority. Nevertheless, according to the overwhelming opinion it can be assumed that minors under the age of 14 years old are not yet capable of consent. The authority for consent lies with the parents or guardians. Because children are normally only accompanied by one of the parents when visiting a doctor, in routine practice the 3-stage theory developed by the Federal High Court pays a deciding role. According to this theory, for routine cases the doctor can assume that one of the parents is basically a representative of the other; for more complicated or severe cases the doctor must satisfy himself that this is true. For patients over 14 years old, the doctor must ascertain whether the patient is capable of consent. Even though a 15-year-old patient for example, can possess the necessary power of judgement and therefore be considered capable of consenting to routine measures or simple interventions, such as taking a blood sample, the yardstick for higher-risk operations, even routine ones is much higher.

[Skin burns under application of electro-surgical devices: aspects of liability and medicine]. / Hautverbrennungen bei Einsatz von Elektrochirurgiegeräten. Haftungsrechtliche und medizinische Aspekte.

Under established jurisdiction,burn damage to the skin in connection with the use of coagulating current is not regarded as unavoidable. On the contrary, a breach of duty by the surgeon will be assumed.He is responsible for acquainting himself with the techniques and the risks of the high-frequency surgical devices he is using.He has to prevent injuries on the basis of controllable risks, even those which only appear as a result of cooperation with other specialist. The evaluation of judicial decisions, the literature, damage reports and expert opinions confirms that most injuries could have been avoided by compliance with the recommended precautions.

[Analysis of claims for damage in the gynaecological sector during 1997 based on data taken from the Professional Association of Gynaecologists' third-party liability group insurance]. / Auswertung gynäkologischer Schadensmeldungen aus dem Jahre 1997 anhand von Datenmaterial der Haftpflicht-Gruppenversicherung des Berufsverbandes der Frauenärzte.

This survey deals with claims for damages in the gynaecological sector during 1997 brought against gynaecologists covered under the professional association's third-party liability group insurance. These claims are typified and presented according to the tenor of the substantiations. The analysis shows that only in the case of a small percentage of the claims was incorrect treatment conclusively the cause of damage,thus resulting in prompt settlement. With regard to the other claims, the status of each dispute is listed as of June 30, 1998. In view of the difficulty that patients have in proving incorrect treatment and resultant damage (the burden of evidence lying with the patient), the focus of such disputes regularly shifts to allegations of inadequate prior information, since the physician has to prove due provision of the same, and to the assertion that documentation was incomplete, since deficient documentation can act in favour of the patient by alleviating the onus of furnishing proof, even to the extent of transferring such onus to the other party. Consequently, liability risk can be reduced by conscientious provision of prior explanatory information and precise documentation of this information and of the treatment.