Ethical Challenges in Caring for Cancer Patients in the Intensive Care Unit: Advanced Care Pathways and Avoidance of Futility

Abstract

Patients with cancer present many ethical challenges in intensive care unit (ICU) right from the decision to admit. Predicting benefit and assessing futility is a process that continues throughout ICU and influences decisions such as change from curative to supportive intent. A complex interplay of medicine, ethics and economics punctuates key moments in the cancer ICU journey. End of life care is as important as any facet of ICU care and the recognition of the importance of appropriate and patient-centred care is increasing. The fundamentals of collaborative communication between practitioners and patients and their families are pivotal to enhancing high quality end of life care. Advance care directives (ACDs) encompass these tenets and provide a template to enlist the cooperation of the patient into active planning for all possible outcomes. This article will consider the ethical issues of cancer patients in ICU with a focus on identification of futility and the potential role of ACDs.