[Limiting life-prolonging treatments: a practical guidance reflecting the current legislation in Germany]

From the general ethical and legal requirements of medical interventions it can be inferred when life-prolonging treatments can or should be limited: If the intervention has no benefit for the patient and/or the properly informed patient refuses to consent to the intervention. Two questions are especially challenging: When are medical interventions futile? And: How should decisions be made on behalf of incompetent patients? In accordance with prior high court rulings, the new Civil Law legislation in Germany provides three standards for proxy decision making: (1) the patients' written advance directive, (2) oral treatment preferences and substituted judgement, and (3) the patient's best interest. Thereby, (1) has priority over (2) and (2) has priority over (3). In addition, the article discusses conflicts between autonomy and well-being of the patient.