title: [Ethics in intensive care and euthanasia : With respect to inactivating defibrillators at the end of life in terminally ill patients].
abstract: BACKGROUND
  In critically ill patients, intensive care medical procedures allow diseases to be cured or controlled that were considered incurable many years ago. For patients with terminal heart failure or heart disease with other severe comorbidities (cancer, stroke), the questions whether the deactivation of defibrillators is appropriate or must be regarded as active euthanasia may arise.
  
  
  METHODS
  Notable cases from the author's hospital are analyzed. The literature on the topic euthanasia and basic literature regarding defibrillator therapy are discussed.
  
  
  CONCLUSIONS
  It is undisputed that patients as part of their self-determination have the right to renounce treatment. Active euthanasia and the thereby deliberate induction of death is prohibited by law in Germany and will be prosecuted. Passive euthanasia is the omission or reduction of possibly life-prolonging treatment measures. Passive euthanasia requires the patient's consent and is legally and ethically permissible. Indirect euthanasia takes into account acceleration of death as a side effect of a medication. Unpunishable assisted suicide ("assisted suicide") is the mere assistance of self-controlled and self-determined death. Assisted suicide is fundamentally not a criminal offense in Germany. Deactivation of a defibrillator is a treatment discontinuation, which is only permitted in accordance with the wishes of the patient. It is not a question of passive or active euthanasia. Involvement of a local ethics committee and/or legal consultation is certainly useful and sometimes also allows previously unrecognized questions to be answered.
authors.affiliation: Medizinische Klinik II (Schwerpunkte Kardiologie und Angiologie), Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland. hans-joachim.trappe@ruhr-uni-bochum.de.
authors.forename: H-J
authors.initials: HJ
authors.lastname: Trappe
mesh_terms: D003422:Critical Care / Q000941:ethics*; D017147:Defibrillators, Implantable / Q000941:ethics*; D020878:Device Removal / Q000941:ethics*; D004992:Ethics, Medical; D005065:Euthanasia / Q000941:ethics*; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D010166:Palliative Care / Q000941:ethics; D010344:Patient Advocacy / Q000941:ethics; D016414:Resuscitation Orders / Q000941:ethics; D017236:Suicide, Assisted / Q000941:ethics; D013727:Terminal Care / Q000941:ethics*
keywords: Palliative care; Patient rights; Resuscitation orders; Suicide, assisted; Terminal care