[Limits of intensive care--decision making on the way between life and death]

Survival and death are closely related in intensive-care medicine. Both have to be accepted and accounted for when decisions have to be made and activity is required. Only then a sound and truthful process of decision-making is guaranteed. Both, the experienced as well as the novice, need guidelines in this process. The basis of these guidelines lies in quite different aspects of life: juridical, philosophic-ethical and religious. The first part of this paper focuses on the specific setting of neonatal intensive care. Three issues must be considered: The patient is not the direct partner in conversation; illness and its consequences have an impact on the social network of the whole family; mothers quite often suffer from severe guilt feelings, which have to be understood and addressed. The second part describes the essential elements of support on the journey' between life and death. They can be summarized under seven headings: urgent acquisition of all necessary data; the need for medical intervention before optimal level of relevant information is available; the importance of allowing for human time factors; the process of arriving at certain decisions; the dealing with unexpected changes in the course and development of the disease; the cessation of therapy; the parental support in bereavement. The overall emphasis of medical intervention should be to view the patient as human being, not as a treatable subject amongst a setting of numerous medical intervention techniques.