[Limits to the duty to treat in intensive care. 1. Explanation of the guidelines in the DGAI]

Do not resuscitate orders in different countries

Health care decision making in severely ill patients presents many difficult medical, ethical and legal problems. Physicians, including anaesthesiologists, are frequently confronted with dilemmas regarding the appropriateness of risky interventions and the balance of potential benefits versus risks. The risks include not only death and the pain and suffering that are related to the interventions, but also (and arguably more importantly) the burdens of lingering disability, loss of independence and poor quality of life. This review presents recent findings (focusing on papers published between 1999 and March 2001), and explores the background for the introduction of do not resuscitate policies and their use in clinical practice in different countries. Problems with auditing and implementing do not resuscitate policies are highlighted.