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Definition of the problem <p>Due to the natural aging process, back pain occurs more frequently in older people and is one of the most common reasons for doctor visits. Accordingly, the financial burden on the healthcare system resulting from conservative and especially surgical treatments is considerable. Data from statutory health insurance providers suggest that obtaining a&#xa0;second opinion can prevent unnecessary and costly procedures. For this reason, the German Pain Association (Deutsche Gesellschaft für Schmerzmedizin e. V.) and the German Pain League (Deutsche Schmerzliga e. V.) have proposed to make seeking a&#xa0;second opinion legally mandatory for patients covered by statutory health insurance, so that pain-related spinal surgery is no longer performed without an independent second opinion.</p> Arguments <p>A&#xa0;trusting relationship between physician and patient is essential in spinal surgery since it can reduce the asymmetry of knowledge and facilitate individual therapeutic decisions. The obligation to obtain a&#xa0;second opinion weakens such trust, replacing it with institutional control.</p> Conclusion <p>The article shows that a&#xa0;mandatory second opinion before spinal surgery cannot be sufficiently ethically justified. At the same time, however, the current practice of a&#xa0;<i>voluntary</i> second opinion procedure (“Zweitmeinungsverfahren”), as stipulated in the so-called Second Opinion Directive (“Zweitmeinungsrichtlinie”), can have significant positive effects on building trust and, thus, contribute to decreasing “overtreatment” and the associated considerable healthcare costs.</p>

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Wirbelsäulenchirurgie und Ethik bei Älteren – Vertrauen versus Zweitmeinung?

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月13日

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  • Monika Trum

摘要

Definition of the problem

Due to the natural aging process, back pain occurs more frequently in older people and is one of the most common reasons for doctor visits. Accordingly, the financial burden on the healthcare system resulting from conservative and especially surgical treatments is considerable. Data from statutory health insurance providers suggest that obtaining a second opinion can prevent unnecessary and costly procedures. For this reason, the German Pain Association (Deutsche Gesellschaft für Schmerzmedizin e. V.) and the German Pain League (Deutsche Schmerzliga e. V.) have proposed to make seeking a second opinion legally mandatory for patients covered by statutory health insurance, so that pain-related spinal surgery is no longer performed without an independent second opinion.

Arguments

A trusting relationship between physician and patient is essential in spinal surgery since it can reduce the asymmetry of knowledge and facilitate individual therapeutic decisions. The obligation to obtain a second opinion weakens such trust, replacing it with institutional control.

Conclusion

The article shows that a mandatory second opinion before spinal surgery cannot be sufficiently ethically justified. At the same time, however, the current practice of a voluntary second opinion procedure (“Zweitmeinungsverfahren”), as stipulated in the so-called Second Opinion Directive (“Zweitmeinungsrichtlinie”), can have significant positive effects on building trust and, thus, contribute to decreasing “overtreatment” and the associated considerable healthcare costs.