[Dealing with treatment limitations during anaesthesia]

Treatment limitations may create a clinical dilemma during anaesthesia. Because mostly, pre-existing treatment limitations have been decided upon without considering the occurrence of a future medical intervention with its unique circumstances. In case treatment limitations are not reassessed prior to an intervention and a life threatening situation occurs during the intervention, a dilemma may arise between the patient's wishes and physician's actions. For example, overtreatment may occur when treatment limitations are ignored during an intervention without the patient's consent. Or undertreatment may occur if a physician strictly adheres to the treatment limitations without taking the situation of an intervention into account. So, how do we respect a patient's autonomy while striving to provide acute care in the patient's best interests? We suggest (re)considering treatment limitations under anaesthesia with every patient with pre-existing limitations, and ideally, with every fragile patient, prior to an intervention.