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Late terminations of pregnancy (after 14 weeks of gestation) can present physicians and other healthcare professionals with complex medical and ethical challenges. In Germany, such terminations require a specific form of medical indication (a danger of grave impairment to the pregnant woman's physical or mental health). Despite these legal provisions, the decision-making process in individual cases often remains characterized by uncertainty, a lack of transparency and insufficient structural support.

This article offers recommendations for the development of institutional ethics guidelines that can support responsible, transparent, and legally sound decision-making in cases of requests for a late termination of pregnancy.

Based on existing recommendations and experience reports, and on the authors' own reflections, key challenges in decision-making are identified and practical guidance for shaping the decision-making process is derived.

Ethical guidelines can help reduce uncertainty, foster interdisciplinary and ethically informed decision-making, and thereby contribute to improving patient care. This requires the development of clear procedures, defined responsibilities, and transparent decision-making frameworks, as well as the promotion of thoughtful engagement with diverse professional perspectives and individual values. The development and implementation of clinical ethics guidelines can offer meaningful structural support for treatment teams in responsibly managing (cases of) late termination of pregnancy.