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A young, still multimorbid woman aquires infectious endocarditis. Anamnestically severe non-adherence concerning medical advice is reported. Complete cure may only be achieved by performing surgical heart valve replacement, which implies lifelong scrupulous oral anticoagulation postoperatively. Discussion evolves within medical staff, whether surgery should be indicated or not.

Chronic and progressive disease represents a significant risk factor for suicidal behavior. Cancer patients have almost twice the rate of suicides compared to the general population. Based on a case report, the suicidal risk factors for cancer patients are presented. It is further investigated to what extent professional support by a mobile palliative care team can affect the wish for assisted suicide or the suicidal behavior generally among patients receiving palliative care. In addition, the mental impact on individuals, who were witnesses of assisted suicide of relatives or close friends are presented. The occurrence of posttraumatic stress disorder (PTSD), depressions, anxiety disorders and complicated grief (CG) in close family members is shown. However, further research will be necessary to develop adequate support for patients (and their relatives), who plan an assisted suicide.

Suizidgedanken kommen in palliativen Begleitungen bei etwa 10 % der betreuten Menschen zur Sprache, uber verubte Suizide in diesem Kontext wurde bisher erst vereinzelt berichtet. In einem Fallbeispiel wird von der Begleitung eines Patienten mit Bronchuskarzinom berichtet, der nur wenige Behandlungsvorschlage des begleitenden Palliativdienstes aufnahm und seinem Leben und Leiden durch eine Medikamentenintoxikation ein Ende setzte. Es werden ethische Aspekte arztlichen Handelns besprochen und Varianten der Entscheidungsfindung im Behandlungsprozess erortert.

In this paper ethical questions concerning the limitation and termination of medical treatment of comatose patients will be discussed on the basis of a case study. The team is confronted with extremely high communicative and ethical demands, since every person engaged in the treatment and care of the patient should take part in this decision making process. The final responsibility regarding the medical decisions, however, lies with the doctor in charge. In such cases advance directives or living wills are important and should be taken into consideration.