Key Points
Î One of the most ethically controversial issues in intensive care units (ICUs)
is how to respond to requests from surrogates to administer life-prolonging
interventions when clinicians believe those interventions should not be
administered.
Î One reason these cases are difficult is that they bring into conflict
important interests of patients, clinicians, and society.
• Patients have an interest in receiving care consistent with their values and preferences.
• Clinicians have an interest in not being compelled to act against their best understanding
of their professional obligations.
• Society has important interests in protecting individual rights, fostering clinician
professionalism, and ensuring the fair allocation of medical resources.
Î These cases are also difficult because there are generally not clear
substantive rules to which to appeal. Additionally, affected patients are
generally vulnerable by virtue of incapacity, have little choice regarding
their treating clinicians, and have limited ability to seek treatment
elsewhere.
Î The multisociety statement on responding to requests for potentially
inappropriate treatments in intensive care units provides guidance for
clinicians to prevent and manage disputes in patients with advanced critical
illness.