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Drei Etappen in der Entstehungsgeschichte Klinischer Ethikberatung

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Book cover Pragmatische Urteile in der unmittelbaren Patientenversorgung

Part of the book series: Gesundheit und Medizin im interdisziplinären Diskurs ((GESUNDMED))

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Zusammenfassung

Albert R. Jonsen und Robert M. Veatch verankern den Beginn der US-amerikanischen Bioethik in den Jahren um 1970. Innerhalb kurzer Zeit waren wegweisende Monografien – wie Van Rensselaer Potters „Bioethics: Bridge to the future“ (1971) oder Paul Ramseys „Patient as Person“ (1970) – und Aufsatzsammlungen auf den Markt gekommen, wurden eigens akademische Institute – wie das Kennedy Institute of Ethics an der Georgetown University (1971), das Hastings Center (1969) oder das erste Department of Humanities an einer medizinischen Hochschule, dem Penn State College of Medicine (1967) – gegründet, starteten fachbezogene Zeitschriften – wie der Hastings Center Report (1971) und etwas später die Zeitschriften „Law, Medicine and Ethics“ oder „Journal of Philosophy and Medicine“ (beide 1975) – mit ihren ersten Auflagen und schuf die Gesetzgebung – beispielsweise mit der Patient’s Bill of Rights (1973) – neue Herausforderungen für die therapeutische Praxis.

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Notes

  1. 1.

    Etwas später, vgl. Hunt und Arras (1977). Beauchamp und LeRoy (1978).

  2. 2.

    In seinem Beitrag über die Gründungsjahre des Hastings Centers und dessen führende Köpfe schreibt Eric J. Cassell resümierend: „We were mostly pragmatists.“ Cassell (2013), S. 20.

  3. 3.

    Parallel zur Entstehung des Faches „Health Law“ in den US-amerikanischen Rechtswissenschaften, vgl. Annas (1995), S. 88–91. Capron und Michel (1993), S. 30–33.

  4. 4.

    Vgl. Jonsen (2006), S. 24. Veatch (2013), S. 174/175. Baker (2013), S. 299–303. Reich (1994), S. 321–326.

  5. 5.

    Vgl. Tapper (2013), S. 419. Clouser (1993), S. 10.

  6. 6.

    Jonsen (2009), S. 483. Vgl. Light und McGee (1998), S. 1. Fox und Swazey (1984), S. 356/357.

  7. 7.

    „One of the 100 most important books published since World War II“. Reich (2013), S. 86.

  8. 8.

    Snow (1959), S. 4/5.

  9. 9.

    Vgl. DeVries (2002), S. 156–158. Fox (1990), S. 213.

  10. 10.

    Vgl. McGehee und Bordley (1976), S. 383.

  11. 11.

    Vgl. Jonsen (1998), S. 12. Grodin (1995), S. 3–7.

  12. 12.

    Siegler (1978), S. 951.

  13. 13.

    Vgl. Silverman (2012), S. 59/60. Knight (1973), S. 93.

  14. 14.

    Baker (2013), S. 316/317. Vgl. MacIntyre (1977), S. 211. Walters (1989), S. 105–111.

  15. 15.

    Vgl. Sanders und Dukeminier (1977), S. 608–610.

  16. 16.

    Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death (2006), S. 339.

  17. 17.

    Vgl. Rothman (2003), S. 168–189.

  18. 18.

    Vgl. Hosford (1986), S. 65–76. Frewer (2012), S. 9–13. Kohlen (2009), S. 53–68.

  19. 19.

    Vgl. Blacker (1935), S. 1353/1354.

  20. 20.

    Vgl. Steinkamp und Gordijn (2003), S. 93–96. Diese bestanden zum Teil bis in die 1980er-Jahre hinein, vgl. Bader (1982), S. 82/83. Lisson (1982), S. 36. Kosnik (1974), S. 40–42.

  21. 21.

    Vgl. May (1975), S. 24–27. Fost und Cranford (1985), S. 2688.

  22. 22.

    Bosk und Frader (1998), S. 96.

  23. 23.

    Vgl. Critical Care Committee (1976), S. 362/363.

  24. 24.

    Vgl. Brennan (1988), S. 803.

  25. 25.

    Cassem (1979), S. 86.

  26. 26.

    Die maßgebliche Rechtsprechung im hier gesetzten Zeitrahmen erfolgte zudem zu den Fällen Bartling vor dem California Appellate Court 1984, Torres vor dem Supreme Court of Minnesota 1984, Barber vor dem California Court of Appeal 1981, Saikewicz vor dem Supreme Judicial Court of Massachusetts 1977 oder Tarasoff vor dem Supreme Court of California 1976. Sie trugen ebenfalls zur Bekanntmachung der Instrumente der Ethikberatung im Krankenhausbereich bei. Mark P. Aulisio zieht noch den Fall Cruzan aus dem Jahr 1990 hinzu, vgl. Aulisio (2016), S. 549–550.

  27. 27.

    Vgl. Pope (2009), S. 262/263. McCormick (1984), S. 150.

  28. 28.

    Vgl. Hosford (1986), S. 13.

  29. 29.

    Die Familie Quinlan gab selbst zwei Publikationen heraus, Quinlan et al. (1977). Quinlan (2005). Vgl. auch den Roman von: Coupland (1998).

  30. 30.

    Der Rechtsstreit von September 1975 bis März 1976 ist ausführlich dokumentiert in, Robinson (1975). Robinson (1976). Zum Überblick der damaligen US-amerikanischen Rechtsprechung bei Abbruch der künstlichen Ernährung, vgl. Paris und Reardon (1985), S. 2243–2245.

  31. 31.

    Vgl. Devettere (2016), S. 197.

  32. 32.

    Vgl. Stonecipher (2006), S. 593/594.

  33. 33.

    Robinson (1975), S. 13.

  34. 34.

    Vgl. McColl (1976), S. 3. Brandon und Casebeer (1976), S. 10. Robinson (1975), S. 563–568.

  35. 35.

    Vgl. Robinson (1976), S. 287–319.

  36. 36.

    Pence (2004), S. 34.

  37. 37.

    Annas (1979a), S. 54.

  38. 38.

    Ausdrücklich im Urteil des Superior Court, vgl. Robinson (1975), S. 568.

  39. 39.

    Vgl. Robinson (1976), S. 197–207. Jonsen (1997), S. 9.

  40. 40.

    Vgl. Quinlan et al. (1977), S. 225/226.

  41. 41.

    Vgl. Pius XII. (1957), S. 1027–1033. Eidenschink (2009), S. 100–101.

  42. 42.

    Dem Revisionsantrag wurde der gesamte Wortlaut der Ansprache von Papst Pius XII. anlässlich des Internationalen Anästhesistenkongresses in Rom am 24. November 1957 beigefügt, vgl. Robinson (1976), S. 31–40.

  43. 43.

    Ohne seine Quelle anzugeben beruft sich Pius XII. der Sache nach auf den Thomaskommentar (Zur Frage der Erlaubtheit der Verstümmelung) des Dominikaners Domingo Báñez, der die Begrifflichkeit „remedia ordinaria et extraordinaria“ in die katholische Tradition einführte. Vgl. Panicola (2004), S. 12.

  44. 44.

    Robinson (1976), S. 203. Explizit wird auch im unten zu besprechenden Bericht der Präsidentenkommission von 1983 die katholische Position zur Unterscheidung der Verhältnismäßigkeit der Mittel diskutiert, President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983a), S. 82–90, besonders 82/83, Fußnote 114 sowie 88/89, Fußnote 132. Vermutlich taucht sie auch deswegen dort auf, da in der Erklärung zur Euthanasie der Kongregation für die Glaubenslehre „Iura et bona“ (DH 4660–4666) vom 5. Mai 1980 diese Lehre bestätigt wurde. Seither ist die Auseinandersetzung um die therapeutische Anwendbarkeit dieser Unterscheidung nicht beendet, vgl. Bayer (1986), S. 90–92. Wildes (1996), S. 511/512. McCartney (1980), S. 219–222. Sullivan (2007), S. 391–393. Calipari (2004), S. 393/394. Bradley (2009), S. 374.

  45. 45.

    Vgl. Robinson (1976), S. 310. Zum grundsätzlichen therapeutischen Problem einer klaren Bestimmbarkeit der Unterscheidung, Gillon (1986), S. 261. McColl (1976), S. 6. Savage (1980), S. 88.

  46. 46.

    Auch die American Medical Association hatte in einer Stellungnahme zur Euthanasie vom 4. Dezember 1973 auf die klassische Unterscheidung des Mitteleinsatzes bezüglich der Rechtfertigung zur Unterlassung unverhältnismäßiger Maßnahmen zurückgegriffen. Vgl. Ashley und O’Rourke (1978), S. 390. Rachels (1975), S. 78.

  47. 47.

    Robinson (1976), S. 311.

  48. 48.

    Vgl. Spielman (2007), S. 41. Munson (2009), S. ix–xvii.

  49. 49.

    Vgl. Heitman (1995), S. 409.

  50. 50.

    Teel (1975), S. 8.

  51. 51.

    Teel (1975), S. 8. Vgl. Levine (1977), S. 27.

  52. 52.

    Teel (1975), S. 9.

  53. 53.

    Teel (1975), S. 9.

  54. 54.

    Robinson (1976), S. 312.

  55. 55.

    Robinson (1976), S. 313. Vgl. Swazey (1980), S. 151.

  56. 56.

    Vgl. Robinson (1976), S. 315. Rothman (2003), S. 229. Stevens (2000), S. 141/142.

  57. 57.

    Robinson (1976), S. 316.

  58. 58.

    Vgl. Beresford (1977), S. 77.

  59. 59.

    Vgl. Quinlan et al. (1977), S. 307.

  60. 60.

    Zitiert nach: Colen (1976), S. 19.

  61. 61.

    Nach ihrem Tod wurden Gehirn und Rückenmark neuropathologisch ausführlich untersucht, vgl. Kinney et al. (1994), S. 1472–1474.

  62. 62.

    Hirsch und Donovan (1977), S. 273.

  63. 63.

    Annas (1976), S. 30.

  64. 64.

    Vgl. Congress of the United States (1987), S. 128. Pearlman (1997), S. 260.

  65. 65.

    Robinson (1976), S. 312.

  66. 66.

    Vgl. Sweeney (1987), S. 183. Paul W. Armstrong, der Anwalt der Quinlans, wies später auf die Gefahren der Verantwortungsdelegation an Ethikkomitees hin und plädierte für eine beratende Rolle: „The surrogates for an incapacitated person and the health-care professionals should be the primary decision makers who, through the vehicle of the ethics committee, seek the keener insight of an interdisciplinary view in deciding on their course of action.“ Armstrong (1984), S. 51.

  67. 67.

    Vgl. Superintendent of Belchertown State School vs. Saikewicz (1998), S. 157. Pozgar (2013), S. 128. Veatch (1988), S. 232–235.

  68. 68.

    Vgl. Annas (1979b), S. 381/382. Wolf (1986), S. 13.

  69. 69.

    Vgl. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983a), S. 463–466.

  70. 70.

    Vgl. New Jersey State Department of Health (1984), S. 388–391.

  71. 71.

    Vgl. Sass (1988), S. 73.

  72. 72.

    Robinson (1976), S. 312.

  73. 73.

    Teel (1975), S. 9.

  74. 74.

    Robinson (1976), S. 308.

  75. 75.

    Diese damalige Vorgabe spiegelt sich knapp vierzig Jahre nach dem Quinlan-Urteil nach wie vor in den Erwartungen der in der klinischen Patientenversorgung Tätigen an die Ethikkomitees wider, vgl. Marcus et al. (2015), S. 18–23.

  76. 76.

    Pellegrino (1988), S. 3. Pellegrino (1999), S. 12.

  77. 77.

    Robinson (1976), S. 313.

  78. 78.

    Vgl. Prip und Moretti (1997), S. 147/148.

  79. 79.

    Frewer (2012), S. 13.

  80. 80.

    Vgl. Rosner (1985), S. 2694.

  81. 81.

    Veatch (1977), S. 25. Vgl. Veatch (1979), S. 522. Veatch (1981), S. 3.

  82. 82.

    Vgl. Ross et al. (1986), S. 6. Eine Vorreiterrolle übernahm ab 1982 das Minnesota Network for Institutional Ethics Committees, Cranford und Van Allen (1985), S. 22/23. Dort finden sich bereits konkrete Aufgabenbeschreibungen, vgl. Minnesota Medical Association – Committee on Ethics and Medical-Legal Affairs (1985), S. 611/612.

  83. 83.

    Vgl. Younger et al. (1983), S. 443–449.

  84. 84.

    Vgl. Kalchbrenner et al. (1983), S. 47.

  85. 85.

    Vgl. Murphy (1990), S. 326/327.

  86. 86.

    Vgl. Rosenblum und Grant (1986), S. 391–393.

  87. 87.

    Die detaillierte Krankheitsgeschichte wird geschildert in, Pless (1983), S. 664. Placencia und McCullough (2011), S. 374–376. Koop (1987), S. 42/43. Kuhse und Singer (1993), S. 39–46.

  88. 88.

    Vgl. Evans (2008), S. 211–215. Sarno (1987), S. 202/203. Meilaender (1982), S. 318.

  89. 89.

    Smith (1986b), S. 789.

  90. 90.

    Der Rehabilitation Act von 1973 wurde als bundesgesetzliche Anti-Diskriminierungsnorm zum Schutz und zur Förderung von Menschen mit Behinderung eingeführt, vgl. Vaughn Switzer (2003), S. 24–28.

  91. 91.

    Vgl. Paris und Fletcher (1983), S. 210/211.

  92. 92.

    Vgl. Cosby (1982), S. 705.

  93. 93.

    Zitiert nach, Annas (1984b), S. 619. Vgl. Smith (1984), S. 713. DeCruz (2001), S. 404.

  94. 94.

    Vgl. Merrick (1992), S. 46.

  95. 95.

    Vgl. Roddey Holder (1985), S. 90. American Academy of Pediatrics – Committee on Bioethics (1983), S. 565. Annas (1993), S. 18/19.

  96. 96.

    Capron (1983), S. A15.

  97. 97.

    American Academy of Pediatrics – Committee on Bioethics (1983), S. 566. Vgl. Strain (1983), S. 443/444. Smith (1982), S. 1137.

  98. 98.

    Vgl. Drane (1994), S. 107.

  99. 99.

    Annas (1983), S. 27.

  100. 100.

    Hosford (1986), S. 55.

  101. 101.

    Vgl. Committee on the Legal and Ethical Aspects of Health Care for Children (1983), S. 204.

  102. 102.

    Vgl. Doudera (1983), S. 202.

  103. 103.

    Zur US-amerikanischen Rechtsprechung in ähnlichen Fällen, vgl. Pence (2004), S. 217–220.

  104. 104.

    Vgl. Horan und Balch (1985), S. 54–58.

  105. 105.

    Annas (1984c), S. 727.

  106. 106.

    Vgl. Kerr (1984), S. 7. Paige und Karnofsky (1986), S. 261/262.

  107. 107.

    Vgl. Roddey Holder (1985), S. 93/94.

  108. 108.

    Vgl. Steinbock (1984), S. 14.

  109. 109.

    Vgl. Annas (1984c), S. 728.

  110. 110.

    Vgl. Biklen und Ferguson (1984), S. 5.

  111. 111.

    Vgl. N. N. (1992), S. 318. Lawlis Kuzma (1984), S. 391–400.

  112. 112.

    Vgl. Todres (1985), S. 256.

  113. 113.

    Annas (1984b), S. 619. Vgl. Klinefelter (1984), S. 425/426. Brown (1986), S. 244.

  114. 114.

    Riga (1984), S. 256. Vgl. Engelhardt (1986), S. 247, Endnote 56.

  115. 115.

    Ein erster Vorentwurf wurde publiziert: American Academy of Pediatrics (1983), S. 6/7. Von der Fachgesellschaft wurde folgender Text veröffentlicht, American Academy of Pediatrics Infant Bioethics Task Force and Consultants (1984), S. 306–310. Vgl. Walker (1988), S. 563/564. Nach mehrfacher Aktualisierung findet sich die derzeitig gültige Version unter: American Academy of Pediatrics (2001), S. 205–209.

  116. 116.

    Vgl. Johnson und Thompson (1984), S. 729. Fleming et al. (1990), S. 780/781.

  117. 117.

    Vgl. Black (1987), S. 272 und 274.

  118. 118.

    Vgl. Smith (1984), S. 721. Reiser (1986), S. 210/211.

  119. 119.

    Vgl. Annas (1984b), S. 620.

  120. 120.

    American Academy of Pediatrics – Committee on Bioethics (1983), S. 566.

  121. 121.

    Caplan (1992), S. 110/111. Goldworth und Stevenson (1989), S. 121.

  122. 122.

    Frohock (1986), S. 135. Vgl. Moss (1987), S. 632.

  123. 123.

    Vgl. Barry (1985), S. 363–365.

  124. 124.

    Fleischman und Murray (1983), S. 5.

  125. 125.

    Smith (1986a), S. 130.

  126. 126.

    Vgl. Smith (1984), S. 721.

  127. 127.

    Haddon (1985), S. 582 Fußnote 130.

  128. 128.

    Vgl. Superintendent of Belchertown State School vs. Saikewicz (1998), S. 157.

  129. 129.

    Vgl. Berg et al. (2001), S. 122/123.

  130. 130.

    Vgl. Robertson (1984), S. 444. Robertson (1986), S. 228.

  131. 131.

    Fost (1999), S. 2041.

  132. 132.

    Jonsen (1998), S. 109. Vgl. Placencia und McCullough (2011), S. 375.

  133. 133.

    Vgl. Gray (1995), S. 263–269. Annas (1988), S. 325–333.

  134. 134.

    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1982), S. 6.

  135. 135.

    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1982), S. 187.

  136. 136.

    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1982), S. 188.

  137. 137.

    Vgl. Bernat (2008), S. 110.

  138. 138.

    Vgl. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983b), S. 3.

  139. 139.

    Vgl. Hosford (1986), S. 23.

  140. 140.

    Vgl. Winkler (1985), S. 81–84. Atkinson (1984), S. 36–41/70.

  141. 141.

    Vgl. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983a), S. II.

  142. 142.

    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983a), S. 160–170. Vgl. Lynn (1984), S. 25–30.

  143. 143.

    Zudem findet die Klinische Ethikberatung zu Beginn des zweiten Teils („Patient Groups Raising Special Concerns“, S. 119) und darin bei der Darstellung der derzeitigen Rechtsprechung (viertes Kapitel, S. 155–157), im fünften Kapitel zu dauerhaft bewusstlosen Patienten (194/195) sowie im sechsten Kapitel zu den schwer erkrankten Neugeborenen (227) kurz Erwähnung.

  144. 144.

    Baker (2013), S. 305.

  145. 145.

    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983a), S. 161.

  146. 146.

    Vgl. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983a), S. 160/161. Cranford und Van Allen (1985), S. 20–22.

  147. 147.

    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983a), S. 162.

  148. 148.

    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983a), S. 160.

  149. 149.

    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983a), S. 163.

  150. 150.

    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983a), S. 163.

  151. 151.

    Diese Funktion wirkt eingeschoben, weil sie weder in der vorangestellten Übersicht (160) auftaucht, noch zur dritten und vierten Funktion passt.

  152. 152.

    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983a), S. 164.

  153. 153.

    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983a), S. 164.

  154. 154.

    Vgl. Capron (1984), S. 174–185, 183/184. Viafora (2005), S. 185/186.

  155. 155.

    Vgl. Morrison et al. (1989), S. 86.

  156. 156.

    An dieser Stelle fügt die Präsidentenkommission einen Vorschlag ein, der sich später nicht durchgesetzt hat. Sie empfiehlt alle Therapieentscheidungen bei schwer erkrankten Neugeborenen und bei Patienten, die keinen „natural surrogate“ haben, einem Review zu unterziehen, vgl. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983a), S. 167.

  157. 157.

    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1983a), S. 168. Vgl. Cranford und Doudera (1984), S. 13.

  158. 158.

    Vgl. Bartholome (1994), S. 8/9.

  159. 159.

    Vgl. Younger et al. (1983), S. 443–449.

  160. 160.

    Vgl. Gilson und Kushner (1986), S. 9.

  161. 161.

    Vgl. Bard (1990), S. 259/260. Rabkin et al. (1976), S. 364.

  162. 162.

    Vgl. Levine (1984), S. 9. Speziell zu den „Infant Bioethics Committees“, Carter (1993), S. 144.

  163. 163.

    Vgl. Purtilo (1984), S. 985.

  164. 164.

    New York State Task Force on Life and the Law (1997), S. 347. Diese Form der „Bioethics Review Committees“ sollte immer – auch bei keinem geäußerten Konflikt der beteiligten Parteien – drei sensible Fallgruppen in einen Review nehmen: 1) wenn ein gesetzlicher Vertreter möchte, dass eine Therapiebegrenzung oder -beendigung beim anvertrauten Patienten durchgeführt wird, der weder an einer unheilbaren, tödlich verlaufenden Erkrankung leidet, noch dauerhaft bewusstlos ist; 2) wenn eine Entscheidung zum Verzicht auf lebenserhaltende Maßnahmen zu treffen ist und keine gesetzliche Vertretung verfügbar bestimmt ist; 3) wenn ein reif wirkender Jugendlicher wünscht auf lebenserhaltende Maßnahmen zu verzichten. Vgl. Veatch (1995), S. 426. Moreno (1993), S. 9/10.

  165. 165.

    Vgl. American Hospital Association (1986), S. 110/111.

  166. 166.

    Vgl. Sherman (1984), S. 131.

  167. 167.

    American Hospital Association (1986), S. 110.

  168. 168.

    Vgl. American Medical Association (1986), S. 112/113.

  169. 169.

    American Medical Association (1986), S. 112.

  170. 170.

    Vgl. Department of Health and Human Services (1985), S. 14893–14901. Child Abuse and Neglect Prevention and Treatment: Final Rule (1998), S. 238–246. Annas (1984a), S. 844. Bopp und Nimz (1992), S. 96–99.

  171. 171.

    Vgl. Gerry und Nimz (1987), S. 342–355. Mumaw (1985), S. 528.

  172. 172.

    Department of Health and Human Services (1985), S. 14893. Vgl. Shapiro und Barthel (1986), S. 847–853.

  173. 173.

    Vgl. Gostin (1985), S. 67–70.

  174. 174.

    Vgl. Department of Health and Human Services (1985), S. 14894.

  175. 175.

    Department of Health and Human Services (1985), S. 14894.

  176. 176.

    Vgl. Fost (1992), S. 289.

  177. 177.

    Department of Health and Human Services (1985), S. 14894.

  178. 178.

    Weir (1987), S. 105–107.

  179. 179.

    Vgl. Capron (1986), S. 17.

  180. 180.

    Department of Health and Human Services (1985), S. 14894.

  181. 181.

    Deswegen ergänzen die Model Guidelines: „or upon court order, or as otherwise required by law“, Department of Health and Human Services (1985), S. 14894.

  182. 182.

    Vgl. Hoffmann (1991), S. 748.

  183. 183.

    Fletcher (1990), S. 5.

  184. 184.

    Vgl. Fretwell (1998), S. 358. Baker (2013), S. 304.

  185. 185.

    Joint Commission on Accreditation of Healthcare Organizations (1992), S. 82.

  186. 186.

    Joint Commission on Accreditation of Healthcare Organizations (1992), S. 104.

  187. 187.

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    Bernhard Bleyer

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Bleyer, B. (2019). Drei Etappen in der Entstehungsgeschichte Klinischer Ethikberatung. In: Pragmatische Urteile in der unmittelbaren Patientenversorgung. Gesundheit und Medizin im interdisziplinären Diskurs. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58672-3_2

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