Ethics in the intensive care unit: Responding to requests for potentially inappropriate therapies in adults
- Douglas B White, MD, MAS
Douglas B White, MD, MAS
- Associate Professor of Critical Care Medicine; Director, Program on Ethics and Critical Care Medicine
- University of Pittsburgh Medical Center
- Section Editors
- Polly E Parsons, MD
Polly E Parsons, MD
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Critical Care
- Professor of Medicine
- University of Vermont College of Medicine
- Robert M Arnold, MD
Robert M Arnold, MD
- Editor-in-Chief — Palliative Care
- Section Editor — General Principles of Palliative Care
- Chief, Section of Palliative Care and Medical Ethics
- University of Pittsburgh School of Medicine
Clinicians are sometimes faced with requests to provide treatments for patients in the intensive care unit (ICU) that they judge to be ill-advised. These requests often arise due to poor communication regarding prognosis and treatment goals between the treating team and the patient and/or his or her surrogates. Sometimes, such requests arise because of value disagreements between the clinicians, the patient, and/or his or her surrogates about what the goals of care should be in light of a serious medical situation.
Issues related to requests for potentially inappropriate treatments and strictly futile interventions are reviewed here. Throughout the discussion, the term "surrogates" will include the person named by the patient to make health care decisions plus any person involved in making decisions for an incapacitated patient. Other issues related to issues that arise in the ICU, palliative care, and end of life care are discussed separately.
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- PREVENTION OF CONFLICTS
- CONFLICT RESOLUTION
- Responding to requests for potentially inappropriate interventions
- Six-step process to conflict resolution
- TIME PRESSURED DECISIONS
- Responding to requests for physiologically futile interventions
- CONSCIENTIOUS OBJECTION AND REQUESTS FOR POTENTIALLY INAPPROPRIATE TREATMENT
- Do-not-escalate-treatment orders
- SUMMARY AND RECOMMENDATIONS