Intensive Care Medicine

, Volume 42, Issue 3, pp 422–425 | Cite as

How should clinicians respond to requests for potentially inappropriate treatment?

  • Gabriel T. BossletEmail author
  • Jozef Kesecioglu
  • Douglas B. White
What's New in Intensive Care


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. This article will outline the framework provided by a new multi-society consensus statement regarding such requests.

Several recent studies suggest that disputed requests for treatment in ICUs in North America and Europe are common. One survey of European ICUs demonstrated that 27 % of practitioners believed they provided inappropriate care to a patient on the day of the study [1]. Recently, a single-center study demonstrated that up to 20 % of ICU patients were perceived by physicians as receiving at least “probably futile” treatment [2]. While there is considerable methodological heterogeneity among these studies, it appears that conflicts regarding treatment requests in ICUs are not infrequent.

Previous guidelines from professional...


Inappropriate Treatment Fair Process Futile Intervention Discretionary Treatment Societal Consensus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with ethical standards

Conflicts of interest

The authors have no conflicts of interest related to this work.


  1. 1.
    Piers RD, Azoulay E, Ricou B, Dekeyser Ganz F, Decruyenaere J, Max A, Michalsen A, Maia PA, Owczuk R, Rubulotta F, Depuydt P, Meert AP, Reyners AK, Aquilina A, Bekaert M, Van den Noortgate NJ, Schrauwen WJ, Benoit DD, ESICM ASGotESot (2011) Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. JAMA 306(24):2694–2703. doi: 10.1001/jama.2011.1888 CrossRefGoogle Scholar
  2. 2.
    Huynh TN, Kleerup EC, Wiley JF, Savitsky TD, Guse D, Garber BJ, Wenger NS (2013) The frequency and cost of treatment perceived to be futile in critical care. JAMA Intern Med 173(20):1887–1894. doi: 10.1001/jamainternmed.2013.10261 CrossRefGoogle Scholar
  3. 3.
    American Medical Association (1999) Medical futility in end-of-life care: report of the Council on Ethical and Judicial Affairs. JAMA 281(10):937–941Google Scholar
  4. 4.
    Society of Critical Care Medicine (1997) Consensus statement of the Society of Critical Care Medicine’s Ethics Committee regarding futile and other possibly inadvisable treatments. Crit Care Med 25(5):887–891CrossRefGoogle Scholar
  5. 5.
    American Thoracic Society (1991) Withholding and withdrawing life-sustaining therapy. Ann Intern Med 115(6):478–485CrossRefGoogle Scholar
  6. 6.
    Bosslet GT, Pope TM, Rubenfeld GD, Lo B, Truog RD, Rushton CH, Curtis JR, Ford DW, Osborne M, Misak C, Au DH, Azoulay E, Brody B, Fahy BG, Hall JB, Kesecioglu J, Kon AA, Lindell KO, White DB, American Thoracic Society ad hoc Committee on Futile and Potentially Inappropriate Treatment, American Thoracic Society, American Association for Critical Care Nurses, American College of Chest Physicians, European Society for Intensive Care Medicine, Society of Critical Care (2015) An Official ATS/AACN/ACCP/ESICM/SCCM policy statement: responding to requests for potentially inappropriate treatments in intensive care units. Am J Respir Crit Care Med 191(11):1318–1330. doi: 10.1164/rccm.201505-0924ST CrossRefGoogle Scholar
  7. 7.
    Prendergast TJ (1997) Resolving conflicts surrounding end-of-life care. New Horiz 5(1):62–71PubMedGoogle Scholar
  8. 8.
    Fine RL, Mayo TW (2003) Resolution of futility by due process: early experience with the Texas Advance Directives Act. Ann Intern Med 138(9):743–746CrossRefGoogle Scholar
  9. 9.
    ASBH (2011) ASBH core competencies for health care ethics consultation, 2nd edn. American Society for Bioethics and Humanities, GlenviewGoogle Scholar
  10. 10.
    Engelhardt HT Jr (1998) Critical care: why there is no global bioethics. J Med Philos 23(6):643–651. doi: 10.1076/jmep.23.6.643.2555 CrossRefGoogle Scholar
  11. 11.
    General Medical Council (2010) Treatment and care towards the end of life. Accessed 30 Dec 2014
  12. 12.
    Garland A, Connors AF (2007) Physicians’ influence over decisions to forego life support. J Palliat Med 10(6):1298–1305. doi: 10.1089/jpm.2007.0061 CrossRefGoogle Scholar
  13. 13.
    van der Heide A, Deliens L, Faisst K, Nilstun T, Norup M, Paci E, van der Wal G, van der Maas PJ, Consortium E (2003) End-of-life decision-making in six European countries: descriptive study. Lancet 362(9381):345–350. doi: 10.1016/S0140-6736(03)14019-6 CrossRefGoogle Scholar
  14. 14.
    Misak CJ, White DB, Truog RD (2014) Medical futility: a new look at an old problem. Chest 146(6):1667–1672. doi: 10.1378/chest.14-0513 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  1. 1.Division of Pulmonary, Allergy, Critical Care, Occupational, and Sleep MedicineIndiana University School of MedicineIndianapolisUSA
  2. 2.Intensive Care MedicineUniversity Medical Center-UtrechtUtrechtThe Netherlands
  3. 3.Critical Care Medicine, Center for Bioethics and Health LawUniversity of PittsburghPittsburghUSA

Personalised recommendations