Matthias Thöns tells the case of Klaus, an 86-year-old former conductor with heart rhythm problems, depression, severe strokes, dementia and increasing care dependency. His sons stated that he would not have wanted apparatus medicine if he became dependent on care, but no written advance directive existed and a professional guardian handled decisions.
As Klaus's condition deteriorated, signs of the dying phase were present: bedbound status, increasing sleepiness, problems swallowing and rattling breathing. Instead of a palliative approach, he was sent for extensive dental treatment and later transferred to hospital as an emergency. There he underwent blood tests, CT, gastroscopy, transfusions, infusions and artificial nutrition, without meaningful improvement.
When he returned to the nursing home, he was deeply comatose, sweating, breathing rapidly with rattling and showing stress signs. The recommendation was morphine for symptom relief and a limitation of infusion treatment. The guardian initially resisted because of misconceptions about morphine and an assumed obligation to provide extensive fluids.
Thöns explains that, in the treatment of a dying person, the professional medical goal is relief of suffering. Measures that merely prolong the dying phase are not indicated and are not something a guardian can demand or a physician should perform. Klaus died some weeks later with good symptom relief.
The article criticizes the preceding dental and hospital treatment as overtreatment that brought pain and suffering without benefit. It argues that non-indicated interventions are ethically problematic and, in legal terms, every medical intervention requires both indication and consent.
Thöns places the case in a broader system problem. Since the introduction of diagnosis-related payment systems, more technical and more profitable interventions can create financial incentives. Severely ill and dying people are particularly vulnerable, often unable to express their will and easily influenced by shock, fear or family pressure. Hospice and palliative advocates, he argues, must now defend the rights of dying people against such developments.
