• J K Schubert and G F Nöldge-Schomburg.
• Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Medizinische Fakultät, Universität Rostock. jochen.schubert@med.uni-rostock.de
• Zentralbl Chir. 2001 Sep 1;126(9):717-21.

AbstractMedical treatment requires more than the application of techniques and devices. Knowing the limitations of (intensive) care and respecting patients' will and dignity is as important as technical skills. Limitations of therapy may arise from medical, ethical, legal, and economic reasons. Therapy may be limited through a Do-Not-Resuscitate (DNR) order, or by withholding or withdrawal of treatment. Total withdrawal of treatment ensues from proven brain death when organ donation has been denied or has been accomplished. But legislation as well as ethics and medical science fail to define unequivocal and precise criteria for limitation of treatment. Depending on the kind of disease, its prognosis and the patient's individual situation clinical scenarios can be identified when withholding or withdrawal of treatment may be thought of. The patient's expressed or anticipated wishes play a key role in decision-making on limitation of treatment. If the patient has no more decision making capacities physicians and patient's next of kin have to determine what would be in the patient's best interest. The patient and/or his family, all attending physicians and the nursing staff have to agree when limitation of care is taken into account. Hospital guidelines and written orders will help physicians and nursing staff to manage these difficult situations. Whether treatment has been limited or not, the patient and his family deserve all our medical and psychological skills--until the end.

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