Dealing with prognosis for comatose patients during cardial hypoxic-ischemic encephalopathy - In support of a discourse-pragmatic approach towards establishing ethics for participation and cooperation [Umgang mit prognosen bei komatösen patienten im zuge einer kardialen hypoxisch-ischämischen enzephalopathie - Plädoyer für einen diskurs-pragmatischen handlungsansatz zur etablierung einer ethik der partizipation und kooperation]

Definition of the problem: Along with the progress made in the field of resuscitation medicine, a large number of studies have been dedicated since the 1980s to the prognostic value of resuscitation- and patient-related acute markers. The general intention of prognostic markers is to allow for a prognosis of the healing potential. Prognostic markers do therefore have an impact on the further development of the therapy design. However, the value of such predictors is altered in non-treatment decisions. There are two reasons for this: first, after critical review of the existing literature and in view of the results of our own study, we must conclude that there is to this day no 100-percent-certain prognostic algorithm for patients in a posthypoxic coma. Second, the comatose patient can not be included in the evaluation of prognostic statements. We are therefore faced with the fundamental question: should we let our moral decisions on the brink of life and death be guided by prognostic markers? Arguments and conclusions: The authors answer the question in the affirmative and consider a discourse-pragmatic patient conference to be an adequate moral course of action. The prognostic data thus substitutes as a "silent patient's case" or argument, so that the patient retains his role as potential dialog partner and moral claimant. The impact of prognostic data will weigh in on the decision in the context of a discursive investigation and assessment of the situation. © Springer Medizin Verlag GmbH 2008.