A simmering debate is erupting within Germany’s healthcare system regarding the extent to which life-sustaining treatments should be provided to critically ill patients, particularly the elderly. Andreas Gassen, chairman of the Federal Association of Statutory Health Physicians (KBV), has ignited the discussion, acknowledging its complexity and potential ethical pitfalls.
Gassen’s remarks, published in the “Neue Osnabrücker Zeitung”, followed statements by CDU health policy spokesperson Hendrik Streeck concerning the allocation of expensive medications to elderly individuals. While dismissing any cost-driven or age-based prioritization as “fundamentally wrong and unethical” Gassen raised a critical question: whether a potentially automatic drive to exhaust all medical and technological possibilities exists, regardless of individual patient benefit.
He highlighted a poignant dilemma faced by many physicians. “Abandoning” a patient, admitting the limits of medical intervention, can feel like a personal defeat. However, Gassen questions whether this reluctance sometimes leads to prolonged, potentially unnecessary, treatment cycles. While condemning the assignment of value to a human life, he emphasized that these are not exclusively issues for the elderly, noting the presence of seriously ill individuals across all age groups, particularly in oncology and palliative care settings.
The observation that lifespan isn’t automatically extending healthspan – meaning the period of life spent in good health – is adding a further layer to the debate. Intensified medical interventions, he suggests, are increasingly being delayed into later years, increasing the burden on both patients and the system.
Gassen stressed the necessity of open and sensitive dialogue, rejecting the idea of a single, definitive solution. He underscored that when patients are conscious, decisions regarding treatment pathways should typically be made collaboratively with treating physicians. However, he acknowledged the courage required to advise patients, for example, on choosing a palliative care option versus prolonged intensive care.
Critically, Gassen voiced concern about the potential “commercialization of dying” implying a risk of treatments being extended primarily for financial gain rather than genuine patient benefit. The challenge now lies in fostering a system that prioritizes patient autonomy and well-being while navigating the deeply sensitive and ethically challenging territory of end-of-life care. The debate will undoubtedly require rigorous scrutiny of existing clinical practices and a nuanced consideration of the societal pressures influencing medical decision-making.