[An age of medical paternalism?--Reflections on medical disclosure and patient consent in 19th century Germany].

Research on the history of medical ethics in Germany still regards the nineteenth century as the age of medical paternalism. The authoritarian manner of German physicians is particularly emphasised by assuming that patients were normally not involved in decisions about serious therapeutic measures. This paper will analyse if and how physicians dealt with the issues of medical disclosure and of patient consent concerning surgery and other painful interventions in the first half of the nineteenth century. Physicians rarely dealt with this problem in their articles on medical ethics but reflected, instead, on the issues of disclosure and consent in descriptions of risky therapeutic interventions. They devoted considerable attention to the description of the decision making process, particularly in medical case reports on life-threatening surgery. The benefits hoped for and the risks of the surgical intervention were frequently explained in detail. It was important for them not only to legitimise their adventurous course of action by obtaining patients' consent but also to demonstrate that the seriously ill patients in reality played the active, demanding part in the decision on life-threatening surgery. It is remarkable that, even where patients from lower social classes were concerned, physicians stressed the necessity of obtaining their consent for risky surgical interventions. However, it cannot be established with certainty if the patients were comprehensively informed by the physicians about the risks involved. Nevertheless, physicians' awareness of the necessity of such disclosure, as expressed by their rhetorical "self-fashioning" in the published case reports, is beyond doubt.