Ethics and neurosciences - end-of-life decision making

The article illustrates the ethical principles and the legal context of end-of-life decisions in neurological diseases. After a long time of preference of medical paternalism, patients autonomy has meanwhile developed as standard of medical decision making. Medical interventions are justified by a medical indication and the patients consent. A competent patient may make a decision which is unreasonable from the physicians view. A mentally incompetent patients will can be explored studying his written anticipated advance directive in which he has framed his value priorities. Advance directives have obtained a high grade of liability. In Germany there is not a specific law on patients advance directives. However, the legal practise showed a certain amount of inconsistency. At the moment three draft bills are discussed in the German parliament.