Ethics in the Intensive Care Unit

Abstract

Summary Health care workers in the ICU frequently confront ethical dilemmas. We recommend that they use moral reasoning rather than intuitive analyses to resolve these dilemmas. Specific recommendations are 1. If a patient expresses a wish based on religious or moral values that is contrary to the proposed course of treatment and if the patient makes that wish known while competent, his or her wish should, in nearly all cases, be respected. 2. If the administration of a hospital wishes to institute a rationing policy to conserve ICU resources, that policy should not withhold care on the basis of socioeconomic status, age, or presumptions about patients with a particular disease. 3. If health care workers are fearful of providing care to patients with a contagious and fatal disease such as AIDS, they should recognize that their risk of infection is quite low and that, more importantly, they have an ethical obligation to treat the patient in their care. Although we believe that moral reasoning can be helpful in deciding these complex issues, the importance of a strong physician-patient relationship cannot be overstated. Only communication between doctor and patient can reveal the exact nature of disputes about treatment and provide the basis for the most appropriate resolution of ethical dilemmas.