Ethik in der Intensivmedizin: Wo stehen wir?

Based on a case report, the issue of changing the treatment objective in critically ill patients is discussed. Following the definition of the term "ethics," a short description of traditional ethical theories is given: eudaimonism, deontology, utilitarianism and principlism. The view is advanced that on the one hand each of these ethical paradigms with its content-oriented argument is well suited for illuminating particular aspects of the ethical issues in question: assessment of the quality of life after intensive care therapy has ended; responsibility for the patient as an individual ; distributive justice in the case of scarce resources ; and orientation along predefined guiding principles. On the other hand, due to differences in cultural perceptions it is not possible to derive from these traditional content-oriented paradigms universally valid ultimate justifications for the appropriate approach in every situation. Discourse ethics with its formal argumentation is presented as a complementary alternative. Even in the case of different perceptions the discourse of all involved makes it possible to find a universally accepted course of action. Referring to Immanuel Kant the idea of human dignity is correlated with the principle of individual freedom and, in this context, patient autonomy; this then explains the central importance of the patient's volition. At the same time, the principal difficulty of assessing a living will, inevitably composed without notion of the precise situation at hand, is illustrated, however, without disparaging such an advanced health care directive.