[Ethics of mechanical ventilation in end of life]

Invasiveness of interventions, complexity of diseases and patients' age are increasing in intensive care medicine. Ethical and legal issues are particularly challenging at the end of life of critically ill patients. At the borderline between intensive care and palliative medicine a significant amount of patients suffer from respiratory failure. Modern modes of mechanical ventilation may be able to improve ventilation and quality of life. On the other hand they may oppose a dignified death at the end of a long lasting chronic disease and e. g. prolong the suffering. In contrast to endotracheal intubation and invasive mechanical ventilation NIV enables patients to participate in the decision making process. While under normal circumstances, ethical standards dictate that patients themselves participate in the medical decision making process. For several reasons this is not always possible in intensive care medicine. However, chronically ill patients should get information from experts already at an early stage of the disease, go through a shared decision process and declare their will concerning interventions of intensive care medicine, e. g. mechanical ventilation. With respect to ethical and legal aspects of end of life this paper deals with chances of mechanical ventilation, including its withdrawal and withholding.