ABSTRACT
While I will try to present herein an overview of the most significant trends in the
past few years as they relate to medical ethics in intensive care, truthfully, there is
no specific ethic of intensive care. Of course, technologies that exist only in the
critical care environment such as extracorporeal membrane oxygenation
(ECMO) (1) and left ventricular assist devices (LVAD) (2) bring with themselves
new dilemmas, new crises of conscience regarding their use. But the overwhel-
mingly more common problems encountered there relate to now standard
forms of life-support, such as mechanical ventilation and dialysis-technologies
employable not only outside of the critical care environment, but even at home
for some patients. And of course, the sociocultural dynamics that create conflicts
among doctors, patients, and surrogate decision-makers grow in a multistep
process. So, one can imagine that the majority of ethical dilemmas, as they
flower in the intensive care unit (ICU), truly germinated elsewhere-clinic,
ward, and home. From this perspective, ethical problems, like icebergs, are par-
tially covert and partially overt-partially potential and partially active-at any
point in a patient’s course.
