Critical Illness and End-of-Life Issues: A Global View

An Evaluation of International Medical Ethics at the End of Life

In the United States, we have had considerable difficulty tackling end-of-life issues in the intensive care unit (ICU). With medicine and pharmacology making more and more advances, bedside clinicians are facing questions that were not asked 20 or 30 years ago. The answers (some, but not all) are somewhat nebulous. For the most part, medical specialists seem unwilling or unable to answer or address these questions. Critical care physicians are uniquely placed to address end-of-life issues. The formula used by most critical care physicians is direct communication with the family in an atmosphere in which family members can interact with the medical team. The critical care physicians use many personnel to help them with this task, including ICU nurses and hospital clergy. It is important for the critical care team to address the family's goals for therapy.


Intensive Care Unit Critical Care Critical Illness Critical Care Physician Intensive Care Unit Nurse 


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  1. 1.
    Meel BL. Incidence and patterns of violent and/or traumatic deaths between 1993 and 1999 in the Transkei region of South Africa. J Trauma 2004;57:125–129.CrossRefPubMedGoogle Scholar
  2. 2.
    Heyns Adu P, Benjamin RJ, Swanevelder JP, et al. Prevalence of HIV-1 in blood donations following implementation of a structured blood safety policy in South Africa. JAMA 2006;295:519–526.CrossRefPubMedGoogle Scholar
  3. 3.
    Thiagraj Soobramoney vs. Minister of Health, Province of Kwazulu-Natal, South Africa. Durban Supreme Court Case Number 5846197, August 1997.Google Scholar
  4. 4.
    Language Use and English-Speaking Ability: 2000. Available at Accessed on February 9, 2006.
  5. 5.
    Pope John Paul II. The gospel of life. Available at: Accessed on February 9, 2006.


  1. 6.
    Shaw GB. Prologues. In: The doctor’s dilemma. London: Oldhams Press; 1938:280.Google Scholar
  2. 7.
    Paris JJ. Manslaughter or a legitimate parental decision? The Messenger Case. J Perinatol 1996;16:60–64.PubMedGoogle Scholar
  3. 8.
    Rawls J. Political liberalism. New York: Columbia University Press; 1993:49–50.Google Scholar
  4. 9.
    Nattrass N. The moral economy of AIDS in South Africa. Cambridge: Cambridge University Press; 2004:35–40.Google Scholar
  5. 10.
    Hardin G. The tragedy of the commons. Science 1968;162:1243–1248.CrossRefGoogle Scholar
  6. 11.
    Lyons RA, Wareham K, Hutchings HA, Major E, Fergusen B. Population requirement for adult critical care beds: a prospective, quantitative and qualitative study. Lancet 2000;335:595–598.CrossRefGoogle Scholar
  7. 12.
    Bhagwanjee S. Audit of intensive care utilisation in Kwazulu-Natal.Google Scholar
  8. 13.
    Watters D. Intensive care in Zambia. Intensive Care World 1989;6:211–215.Google Scholar
  9. 14.
    Thiagraj Soobramoney vs. Minister of Health, Province of Kwazulu-Natal, South Africa. Durban Supreme Court Case Number 5846197, August 1997.Google Scholar
  10. 15.
    Levinsky NG. The doctors master. N Engl J Med 1984;311:1573–1575.PubMedCrossRefGoogle Scholar
  11. 16.
    Dyer C. London hospital to face high court for allegedly refusing to resuscitate disabled girl. BMJ 2004;328:125.CrossRefPubMedGoogle Scholar
  12. 17.
    Shaw GB. Prologues. In: The doctor’s dilemma. London: Oldhams Press; 1938.Google Scholar
  13. 18.
    Dörner D. The logic of failure. New York: Basic Books; 1996:17.Google Scholar
  14. 19.
    Illich I. Death undefeated: from mediclisation to systematisation. BMJ 1995;311:1652–1653.PubMedGoogle Scholar
  15. 20.
    Paris JJ, Muir JC, Reardon FE. Ethical and legal issues in intensive care. J Intensive Care Med 1977;12:298–309.Google Scholar


  1. 21.
    Australian College of Critical Care Nurses. Position statement on intensive care nursing staffing. Aust Crit Care 2002;15:6–7.CrossRefGoogle Scholar
  2. 22.
    Venkatesh B, Kruger P, Pascoe RL, Morgan TJ. Intensive care in Australia and New Zealand: past, present and future. Natl Med J India 2004;17:107–108.PubMedGoogle Scholar
  3. 23.
    Pronovost PJ, Angus DC, Dorman T. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA 2002;288:2151–2162.CrossRefPubMedGoogle Scholar
  4. 24.
    Yaguchi A, Truog RD, Curtis JR, et al. International differences in end-of-life attitudes in the intensive care unit. Arch Intern Med 2005;165:1970–1975.CrossRefPubMedGoogle Scholar
  5. 25.
    Carlet J, Thijs LF, Antonelli M, et al. Challenges in end-of-life care in the ICU: statement of the 5th Intenrational Consensus Conference in Critical Care. Brussels, Belgium. April 2003. Intensive Care Med 2004;30:770–784.CrossRefPubMedGoogle Scholar

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