[Clarity and legal authority in decisions to limit therapy]

The decision to limit a patient's therapy can lead to conflicts in the therapeutic team if their views have not been carefully weighed. Further problems also result if they are not clearly and logically documented. The legal authority of patient will, medical indication, and interaction of the care-giving team for arriving at a common decision are examined here. Using a case history as an example, we discuss ethical and legal questions of documentation and obligations on those faced with concrete decisions whether to continue medical procedures. To widen the basis for such decisions, discussion must include the viewpoints of all participants. The final decision must then be clearly documented without any unclarity or ambivalence. Those finally required to carry out that prospective decision, however, must decide whether it actually applies to the situation at hand.