[Saving life and permitting death. Decision conflicts in intensive medicine]

Intensive care has achieved major breakthroughs in handling gravely ill patients. However, this has, at least in part, been overshadowed by problems relating to ethical values as well as general psychological conflicts among patients and hospital staff. When dealing with such problems, distinct criteria are required which address the patient's dignity and will to survive. A four-step scheme is suggested, ranging from maximum therapy, via maintenance therapy without adjustments to increased demand and therapy reduction, to cessation of therapy. In the case of therapy reduction, balanced support is maintained ensuring that dehydration is avoided, the respiratory tract is kept clear, pain killers are used to good effect, personal attention is provided, and care is provided to a high standard. A questionnaire tailored to the practical need of how to arrive at an ethically weighted and accepted decision is presented. When searching for a solution involving ethic issues, it is particularly important to involve all individuals concerned in a dialogue until a consensus is reached.