If immediate decisions are medically necessary, the doctrine is true of the presumed consent. In other cases, the consent must be obtained. Children With most medical decisions affecting minors, medical care can not be carried out without the consent of their parents or guardians. About the decision of their parents or guardians can only be condoned if a court determines that the decision of neglect or abuse of minors is tantamount. In some states, minors can be to make certain medical treatments such without parental permission. As a treatment of sexually transmitted diseases, prescriptions for birth control, abortion. The relevant national law must be consulted. If adults in adult patients the ability to approve or reject medical treatments is lacking, doctors must rely on the consent by proxy. All parking Represented – whether determined on behalf of the patient or by state law or by the court – have the duty to follow the expressed wishes of the patient and to act in the best interest of the patient, taking into account the personal values ??and wishes of the patient, as far as they are known are. When adult patients already have a court-appointed guardian with authority to decide on measures of health care, the guardian is the authorized parking Represented. The guardianship rules should be consulted to obtain information on the extent of the decision-making powers of the guardian. When patients who lack the legal capacity, can present a final health care proxy, the guardian who is mentioned in this document can make decisions within the authority. In general, specific instructions given in an advance directive, or expressed in another previous document when the patient still had full legal capacity, followed, depending on the extent to which the document contains the patient’s wishes. If the decision of an authorized representative or alternate is different from the instructions in this present document, the result of the extent depends on where the agent or representative may make decisions. Normally, the power of attorney granted broad discretion proxies, so that instructions provide guidance and are not binding. Nevertheless, the physician should consider what kind of latitude the document gives the agent on the instructions mentioned there also. Legal advice may be required. When patients have no authorized representative, doctors usually leave to the next of kin or a close friend. However, the discretion of authorized representatives and the priority of living wills from country to country. In states where lawful deputies approved, the typical order of priority is a spouse (or partner in countries that recognize that status), an adult child, a parent, a sibling, and then possibly other relatives or a close friend , If more than one person the same priority (z. B. several adult children), a consensus is preferable but some states allow doctors also to rely on a majority decision. If the decision-making ability of a patient, the authority of a legal deputy or ethical or legal consequence of a particular treatment are controversial, consultation should be held with institutional ethics committee or similar body. If correct agreement can be reached on ethical and legal basis, the doctor or his employer should seek legal counsel. Many institutions make an Ethics Commission available at short notice; judicial review typically takes longer to complete. Leeway The patient’s wish has its limits. For example, doctors are not obliged to carry out treatments that are medically or ethically inappropriate such. For example, those who violate generally accepted medical standards. But sometimes there are legitimate differences of opinion about what is appropriate or inappropriate. To label a treatment as “pointless” is not usually helpful if the treatment can have results that keeps the patient as desirable (except for mortality and morbidity). Doctors do not have to act against their conscience, but if they do not agree with a desired treatment, consultation with an ethics committee should be. You can also their responsibility under state law by justice, by transferring a patient to another doctor or to a desired by the patient hospital.