[Ethics and law in intensive therapy].
BACKGROUND
Intensive therapy is one of the newest areas of medicine. The patient who was thought to be hopeless yesterday is given a chance to survive. As in other fields of medicine parallel with their development, several ethical and legal problems arise and wait for solutions.


OBJECTIVE
Two areas need urgent solutions especially at first ethical then at legal levels. These are the questions of life and death: where is the boundary of euthanasia and can the so called DNR ("Do Not Resuscitate") strategy be applied, which partial therapy withdrawal can be done compatibly with the basic ethical and legal requirement of protection of life. Important question as well, is that where lies the boundary of free self determination. How can be living wills be given when is it necessary to ask for the patient's consent, how much information is to be given to the patient.


METHODS
Based on increasing experiences form Europe and the USA, some of the important fundamental principles of therapy withdrawal of intensive care therapy is outlined. Besides the above described questions, a short description of the Hungarian conditions will be given.


RESULTS
Although the number of declarations given by professional corporations increase decisions of the jury help the medical practitioner in making his difficult decisions, but making the individual decision personal communication of the medical staff with the patient or his foster play an important role. Everything is the patient's right of free self determination based on the patient being properly informed. The ethical and even the legal attitude does not consider withdrawal of a widening circle of therapy to a form of euthanasia.


CONCLUSIONS
In the mirror of international experiences concordance is reached in many aspects of therapy withdrawal in intensive care. In the mean time national regulations are not yet available, this is the reason, why based on the international declarations, keeping an eye on the Hungarian practice these regulations should be worked out in the near future.
Elö
Gábor
G
Semmelweis Egyetem, Altalános Orvostudományi Kar, Aneszteziológiai és Intenzív Terápiás Klinika, Budapest. gelo@kut.sote.hu
Pénzes
István
I
D003245:Consensus Statements as Topic; D003422:Critical Care / Q000941:ethics* / Q000331:legislation & jurisprudence*; D026690:Ethics, Clinical; D004992:Ethics, Medical; D006801:Humans; D006814:Hungary; D007258:Informed Consent; D028701:Patient Rights; D026684:Personal Autonomy; D016414:Resuscitation Orders; D028761:Withholding Treatment