Requests for Potentially Inappropriate Treatments In Intensive Care Units

Publication Date: March 2, 2015

Key Points

Key Points

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.

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.
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.

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.

Recommendations

...ecommendati...

...itutions should implement strategies to prevent...


...he term “potentially inappropriate” shoul...


...less-common situations for which the comm...


...profession should lead public engagement effor...


.... Recommended Approach for Management...


...Recommended Practices for Improvin...


Management

...anagement

...2. Categories of Disputed Treatments in Int...


...le 3. Recommended Steps for Resolution of...


...e 4. Questions to Assist in Illuminating Mo...


...ble 5. Examples of Questions for Public Engag...