[Decision making in borderline situations--anesthesiological aspects]

Over the last few decades, major biomedical developments have been taken place so that dying and death are nowadays more a matter of deliberate decision--a change that has profound ethical and legal implications. This progress has influenced medical decision-making generally and intensively, especially that of the surgeon and the anaesthesiologist. The representatives of these professions are often confronted with problems of life-sustaining therapy at the beginning and the end of life and of resuscitative measures. The surgeon and the anaesthesiologist have to accept the necessity of close partnership while maintaining a clear dividing-line between their responsibilities, but at the same time jointly doing their utmost for the good of the patient. Above all the physician has to give due consideration to the patient's will, but there are many and sometimes great variations in the individual situations of conscious or permanently unconscious patients. The highest courts in Germany have laid down that the principles of medical ethics must supplement the law.