ABSTRACT
Ethical considerations in the intensive care setting revolve around the behaviors, expectations, and actions of the patient, the healthcare providers, and the legal system. The technological capabilities within the intensive care unit (ICU) to sustain life have increased the responsibilities of each of these entities to focus on what can be done vs. what should be done. Areas that appear to have the greatest challenges associated with them are effective communication among the patient, family members, and healthcare providers; surrogate decision making; provision of futile care; and termination of care. The turmoil stems in part from the replacement of the primary care physician with an intensivist and the absence of a long-standing relationship and familiarity with the patient and the family. The harsh reality is that 60% of deaths in the United States occur in acute care facilities; 75% of these deaths result after the decision to forgo life-sustaining medical therapy (1). Eightyfive percent of all cancer patients admitted to the ICU die while in the ICU (2). These statistics clearly demonstrate that difficult decisions concerning perpetuation and discontinuation of therapy occur daily in the ICU setting with critically patients, their families, and healthcare providers.
