[Ethical, legal and care-related aspects of the competence to refrain from diagnostics and treatment : Choosing wisely].

BACKGROUND

Acting in the patient's best interest is the foundation of medical practice. Because medical interventions constitute bodily injury, they require justification. Actions that do not serve the patient's welfare or that cannot be substantiated on scientific grounds should be omitted.

OBJECTIVE

How can a physician consciously and responsibly forgo diagnostic or therapeutic measures in the patient's interest?

METHODS

Ethical, epistemic (i.e., knowledge-oriented and insight-oriented) and legal preconditions for the competence to refrain from diagnostics and treatment are examined as a framework for healthcare provision.

RESULTS

The competence in medicine to choose wisely comprises the ability to recognize when screening, diagnostic procedures or treatment are no longer medically indicated or when treatment should be terminated and the ability to articulate, both professionally and humanely, why medical action is not the best option in a given case. This decision must be communicated appropriately to the patient, relatives and the interprofessional team. To do so, physicians need the sovereignty to withstand pressure to act (whether stemming from technology, the team, the institution or societal expectations). For making wise decisions in line with a medical virtue, a physician must set aside, among other things, personal economic interests, the fear-driven adaptation to a perceived high-risk liability environment combined with the desire for legal protection, the deeply socialized impulse to always act (actionism) and one's own convenience.

CONCLUSION

The ethically justified, equitable, resource-conscious, legally mandated, patient-centered and responsible contemporary medicine calls for a competence to refrain from action in every physician.