Some Ethical Principles for Adult Critical Care

Abstract

What follows is an effort to set out the state of the art in approaching several of the most disturbing problems involving end-of-life decision-making in the intensive care setting. Developed as part of the curriculum at the University of Hawaii, this material is intended as a reflection of current work in health care ethics, strongly supported by the literature and generally consistent with current legal trends. But it has also developed into something of a consensus document, having been widely circulated in various versions, repeatedly presented to professional audiences dozens of times in Hawaii, and improved by countless comments and suggestions. While the focus here is upon the standards for withholding and withdrawing treatment, it should be noted that some important types of ethical problems are not covered: in particular, scarce resource problems (including some related questions involving medical futility), maternal-fetal and pediatric issues, and questions involving the notification of potentially affected third parties.