An ongoing qualitative study at the Charité
Berlin is examining the experience of family physicians
with moral conflicts and the potential need for ethical ad-
vice. We analyze a case report from this interview study
by using a principle-oriented approach. During an out-of-
hours service, a family physician is being called to see an
85 years old, previously unknown patient in a nursing
home, who is suffering from angina. On arrival, the pa-
tient apparently has just passed away. The family phys-
ician is confronted with the decision whether or not to
start resuscitation. No details about the patient are
known. The nurse does not know whether an advance
decision has been laid down. The family physician de-
cides against resuscitation, but is unsure about this choice
when reflecting on the case afterwards.
We identify criteria for a retrospective ethical reflection of
the case. The assessment of the medical indication and of
the patient‘s will seems crucial. However, without any
knowledge of the patient‘s preferences this proves to be
insufficient. The recommendation of resuscitation guide-
lines to always begin with resuscitation if in doubt seems
hard to follow without a clear idea of any goal of therapy
that is realistically attainable. The application of the ethi-
cal principles in health care, as formulated by Beauchamp
und Childress (respect for autonomy, nonmaleficence, be-
neficence, and justice), can help to reach a responsible
decision in the best interest of the patient.