Bioethics in Critical Care Patients

Abstract

Intensive care unit is a special medial environment for many reasons (the severity of the patients, the important technological advances). In recent years, the medicine has changed to a more focused practice on the patient, leaving behind the paternalistic medical approach, with a transparent new relationship with the patient and his family. The ethical principles-autonomy, beneficence, non-maleficence and justice-and the possibility of con- flicts between them make decision-making very complex. The admission of these patients in our unit is justified based on a triangle-acute, severe, and recoverable disease-trying to optimize their treatment. Unfavorable later evolution is possible; a palliative management can often be considered, changing the patient ’ s approach from the cure of his illness to the relief of his symptoms. Decisions about patient ’ s future must be jointly made by the health care team, the patient and his family. We must look for documents about previous instruc- tions and/or opinion of a substitute decision-maker. We must humanize our units, think-ing about the best care for the sick person and his family, and improve the support to the family after his death. Therefore, the development of practice guidelines on palliative care should be promoted by the hospitals.