Zusammenfassung
Die Patientenaufklärung ist „täglich Brot“ des klinisch tätigen Anästhesisten und
gleichzeitig ein zentrales Rechtfertigungselement medizinischer Behandlungsmaßnahmen.
Durch Auslösen von Placebo- und Noceboeffekten kann sie den Behandlungserfolg aber
auch selbst maßgeblich beeinflussen. Einem daraus drohenden Konflikt verschiedener
medizinethischer Prinzipien kann mit entsprechenden praktischen Strategien wirksam
begegnet werden.
Abstract
The briefing of patients is part of the daily routine of clinical anaesthesiologists
and a central element for justification of medical treatment. It is increasingly apparent
that such conversations can significantly affect the success of treatment by eliciting
placebo and nocebo effects. Placebo effects are psychosocially caused clinical improvements,
mediated by neurobiological mechanisms, which would be omitted in the case of hidden
application. Nocebo effects are deteriorations, caused by the same mechanism. Anesthesiologists
can make use of the knowledge about placebo and nocebo effects to increase positive
impact on the outcome of treatment and to reduce negative effects at the same time.
To do so legitimately, physicians have to balance the respect for patientsʼ autonomy,
the benevolence, and the non-maleficence for their patients. Patientʼs autonomy remains
the supreme principle of the briefing about treatment and is institutionalized by
the informed consent paradigm. Positive and negative expectations are to be handled
by patient-oriented communication, but hard paternalistic deceptions and omissions
are ethically unjustifiable. We will examine the practical strategies that could be
used to deal with the imminent conflict between profound information and optimising
placebo and nocebo responses. One key stone of these strategies is the pilot model.
It helps to shape briefings as individually required and to promote the wellbeing
and autonomy of our patients at the very same time.
Schlüsselwörter
Placeboeffekt - Noceboeffekt - Aufklärungsgespräch - informierte Einwilligung - Patientenautonomie
- Wohltuen - Nichtschaden - Lotsenmodell
Key words
placebo effect - nocebo effect - briefing of patients - informed consent - patientʼs
autonomy - benevolence - nonmaleficence - pilot model
