[Between patient autonomy and the ethics of care : difficult end-of-life decision-making in intensive care]

The article illustrates the ethical principles and the legal context of end-of-life decision-making in the intensive care unit (ICU). After a long period of preference for medical paternalism, patient autonomy has now developed into the standard for medical decision-making. Medical interventions are justified by medical indications and patient consent. A competent patient may make a decision which is unreasonable from the physician's view. A mentally incompetent patient will can be explored by studying the written anticipated advance directive in which the patient has formulated value priorities. The binding character of patient advance directives was regulated in German law in 2009; the decision has to be made in a dialogue between the physician and the proxy. A judgment of the German High Court in 2010 confirmed that even an active withdrawal of therapeutic measures, such as mechanical ventilation is legal.