[Illegal professional conflict of interest from the viewpoint of the attorney]. / Unerlaubte Zuwendungen aus Sicht des Rechtsanwaltes.

Since the so called "heart-valve scandal" occurred in Germany, the practice of financially or otherwise supported hospitals and practicing doctors has to be critically re-examined and may be changed. The practice and acceptance of support is common in many areas of our daily life, however, due to governmental social laws regulating the flow of money and due to the various financial forms of support for the health care system, criminal violations and sanctions may arise. Aside from the existing standard criminal violations, a new law, as of has been enacted August 13, 1997-this law specifically deals with bribery and the acceptance of such illegal payments. Proving that such a criminal violation was committed by a physician can be very difficult for the prosecutor. The mass of procedural laws--aside from the substantive law requirements--cause problems for the state. It is also very difficult to determine the exact amount of damages or that a physician has gained an illegal advantage. In these specific and other general cases, a professional defense by a competent attorney is absolutely essential to prevent an unpleasant suit or to resolve charges outside of court. In some cases, it may even be possible to persuade the prosecutor to only levy a fine, if it is not possible to persuade him to drop the charges all together--for lack of good evidence.

[The physician between cost control and quality requirements]. / Arzt zwischen Wirtschaftlichkeitsgebot und Sorgfaltspflicht.

In times of reduced monetary resources of the current German health system, it is more and more difficult for the German physicians to comply with the high medicinal care standard and to practice economically. Nevertheless, the economical reasons cannot deny the high medical quality standards. Regarding the principle of the unity of jurisdiction, the validity of the social welfare law, that a performance has to be "just sufficient and suitable", must concur with the demand of liability law of "indication of the medical service". The economical duties reach their limit when they increase the risk for the patient. On the other hand, the economy interests have to be regarded by the "principle of the allowed risk". Therefore, it should be considered that in every single case the severity and probability of the risk has to be weighed against the cost aspect.

[Physician responsibility of confidentiality]. / Die Schweigepflicht des Arztes.

Summarizingly it is to be mentioned that, concerning the professional secrecy, the principle is held that the physician is allowed to speak as much as it is necessary and he must be silent as far as it is possible. The physician is entitled to reveal but not obliged to do so as far as he has been exonerated from the professional secrecy or as far as the revelation is necessary for the protection of a higher legal proceeding. This is taken into consideration also for evidence in judicial proceedings. Apart from legal informational obligations at first, however, not the physician but the patient defines the breadth of allowable infringements. Only when the professional secrecy collides with the legal matters of third persons the physician himself gets into compulsions of decision. Taking into consideration the criminal law the maintenance as well as the infringement of the professional secrecy remain without consequences for the physician, if the translegal critical state is present. In such cases, however, he should endeavour to keep the dangers which brings his silence for others as insignificant as possible.

[The physician as an accident witness: emergency treatment and the problem of failure to treat]. / Der Arzt als Unfallzeuge: Notärztliche Versorgung und Probleme der unterlassenen Hilfeleistung.

As a witness of an accident the physician has always the duty to render first aid. At least he has to examine carefully whether his help is not or no more necessary. On account of his professional abilities the duty to first aid may concern him as the only person also among several participants, and he must always care to take the best possible measures for the prevention of dangers. In the other case he exposes himself the danger of culpability for not having performed first aid. Apart from a penal verdict also the possibility of a verdict by a professional court of justice for the same offence can be added. In the process before the professional court of justice is examined, whether or not the physician failed in his professional duty to protect and restore health as well as to reduce complaints (section 1, number 2 MBO).