[Austrian guideline for palliative sedation therapy (long version) : Results of a Delphi process of the Austrian Palliative Society (OPG)]. / Leitlinie zur Palliativen Sedierungstherapie (Langversion) : Ergebnisse eines Delphiprozesses der Österreichischen Palliativgesellschaft (OPG).

BACKGROUND: Palliative sedation therapy (PST) is an important and ethically accepted therapy in the care of selected palliative care patients with otherwise unbearable suffering from refractory distress. PST is increasingly used in end-of-life care. Austria does not have a standardized ethical guideline for this exceptional practice near end of life, but there is evidence that practice varies throughout the country. OBJECTIVE: The Austrian Palliative Society (OPG) nominated a multidisciplinary working group of 16 palliative care experts and ethicists who established the national guideline on the basis of recent review work with the aim to adhere to the Europeans Association of Palliative Care's (EAPC) framework on palliative sedation therapy respecting Austrians legal, structural and cultural background. METHODS: Consensus was achieved by a four-step sequential Delphi process. The Delphi-process was strictly orientated to the recently published EUROIMPACT-sedation-study-checklist and to the AGREE-2-tool. Additionally national stakeholders participated in the reflection of the results. RESULTS: As a result of a rigorous consensus process the long version of the Austrian National Palliative Sedation Guideline contains 112 statements within eleven domains and is supplemented by a philosophers excursus on suffering. CONCLUSIONS: By establishing a national guideline for palliative sedation therapy using the Delphi technique for consensus and stakeholder involvement the Austrian Palliative Society aims to ensure nationwide good practice of palliative sedation therapy. Screening for the practicability and efficacy of this guideline will be a future task.

[Medical ethics in the undergraduate medical curriculum and in the health care system]. / Ethik und ärztliches Ethos im Medizinstudium und im Gesundheitswesen.

In German speaking areas, in the scientific establishment which is occupied with medical ethics in the narrower and wider senses, a vehement discussion has developed as to whether or not medical practitioners must ultimately advocate that which is understood to be modern medical ethics. Against the background of this discussion, this article takes up a position on these questions, not only theoretically, but also with reference to the fields of practice of medical studies, hospitals, and the health system. The article presents the proposals of the Institute for Ethics and Law in Medicine (University of Vienna) for the evaluation and further development of the theme of ethics within the framework of the Medical Curriculum of Vienna (MCW). Among other things, this requires an integrated model of levels of ethical competence.

[Patient advance directives in Austria--ethical discussions]. / Patientenverfügungen in Osterreich--ethische Diskussionslage.

In Austria exists a broad political consensus to avoid euthanasia and assisted suicide but to convey palliative medicine and palliative care and to strengthen the autonomy and the rights of the patient. Therefore in 2006 the Austrian parliament passed the living will act which differs between obliging and noticeable living will documents. Concerning the limitation of the range of coverage the Austrian law defines a comparative liberal position.

[Don't leave alone! Or maybe do? What it means to acknowledge vegetative patients as human subjects]. / "Lasst mich bloss nicht in Ruhe - oder doch?" Was es bedeutet, Menschen im Wachkoma als Subjekte ernst zu nehmen.

Acknowledging vegetative patients as subjects within the therapeutic and nursing practice requires a clarification of the terms of subject, person and autonomy. There are good reasons for using the terms person and human being synonymously, instead of making the person status of human beings dependent on their state of consciousness. Furthermore, the understanding that the body is the bearer of human personality and the medium of communication is of crucial importance. Like the human countenance, the human body as a whole has got a response structure, too. Hence, it can be argued that the mere presence of a comatose human alone, but also many nonverbal signals and reactions should be understood as a request for communication. How far signals and responses coming from the patient in individual cases can be interpreted as personal messages or as pure body reactions depends, however, very much on the interpretation.

[Illness, culture and religion--issues of intercultural medical ethics and nursing ethics]. / Krankheit, Kultur und Religion--Fragestellungen interkultureller Medizin- und Pflegeethik.

Should modern medicine be allowed to do what it is capable of? And what role are religious norms and attitudes to play in both the medical course of life and the bioethical discourse of modern societies? Questions like these are subject of current intercultural medical and nursing ethics. Religious attitudes not only influence the cultural and political surroundings of medical research but also exert a practical influence on the health and illness attitudes of the individual. Coming before moral judgement should be the endeavour to understand one's counterpart, namely the patient, and his/her socio-cultural background. The question to be answered is how therapy and nursing can best be applied within the given socio-cultural framework without those responsible denying their own medical premises or their own concepts of nursing. Intercultural medical and nursing ethics provide an important contribution to the current debate on integration.