[Therapeutic Decisions Concerning Severe Neurological Diseases and at the End of Life]

Modern medicine increasingly enables survival of life-threatening diseases. On the other side, however, especially in Neurology, the questions have to be addressed how intensive the initial treatment should be and how to deal with residual states when severe functional or cognitive deficits are expected. In these cases, it is not only important to decide which medical measures are appropriate for the patient, but also whether, given the prognosis, the patient would agree with the suggested measures. This article first describes the basis for each medical action, i. e. ethical aspects, medical indication and patient's agreement. Then the different ways to find out the patient's wishes depending on his ability to agree as well as the possibilities for advance directives (including Advance Care Planning) and health care proxies are discussed. Finally, suggestions for adequate documentation are given. In parallel, the relevant legal paragraphs and statements of the German medical association are presented.