Is it possible to define limits of treatment in critical care?

Medical treatment requires more than the application of techniques and devi ces. Knowing the limitations of (intensive) care and respecting patients' w ill and dignity is as important as technical skills. Limitations of therapy may arise from medical, ethical, legal, and economic reasons. Therapy may, be limited through a Do-Not-Recussitate (DNR) order, or by withholding or withdrawal of treatment. Total withdrawal of treatment ensues from proven b rain death when organ donation has been denied or has been accomplished. Bu t legislation as well as ethics and medical science fail to define unequivo cal and precise criteria for limitation of treatment. Depending on the kind of disease, its prognosis and the patient's individual situation clinical scenarios can be identified when withholding or withdrawal of treatment may be thought of. The patient's expressed or anticipated wishes play a key ro le in decision-making on limitation of treatment. If the patient has no mor e decision making capacities physicians and patient's next of kin have to d etermine what would be in the patient's best interest. The patient and/or h is family, all attending physicians and the nursing staff have to agree whe n limitation of care is taken into account. Hospital guidelines and written orders will help physicians and nursing staff to manage these difficult si tuations. Whether treatment has been limited or not, the patient and his fa mily deserve all our medical and psychological skills - until the end.