Ethics consultation in the intensive care unit

Abstract

To review the medical literature for recent reports of the role of ethics consultations in the intensive care setting. Ethical principles can provide important guidelines for dealing with value conflicts in medical treatment decisions, particularly treatment decisions to limit life-sustaining treatment in the intensive care unit. Until recently, advocates of ethics consultations have had to rely on inconclusive supporting data. In the past few years, however, a single-site and multi-site prospective randomized controlled trial of the ethics consultations offered in response to treatment conflicts in the intensive care unit demonstrated significant reductions in hospital days, hospital costs, and ventilator days in patients who did not survive to hospital discharge. The consultations were very well received by all the parties. Ethics consultations seem to be useful in resolving conflicts that may be inappropriately prolonging nonbeneficial or unwanted treatments at the end of life. Further research on whether ethics consultations are beneficial in other settings is needed to establish the optimal scope of this intervention. Also, because these benefits were achieved by highly skilled and experienced consultants, it is not certain how successful other hospitals will be when adopting this intervention.