Ethical issues in resuscitation and intensive care

Advances in the care of critically unwell patients have begun to blur the boundaries between life and death; coupled with an ageing population, intensive care physicians routinely make difficult decisions in their clinical work. The model of supported decision-making with patients has become standard, however, patients in the intensive care unit (ICU) are often unable to express their wishes at the point of admission. Recent legal cases have resulted in increased scrutiny upon the decisions we make when caring for patients unable to consent to treatment, due to incapacity and critical illness, particularly when they involve the limitation or discontinuation of life supporting therapies. A robust understanding and application of the moral, ethical and legal frameworks are useful to aid in making decisions in patients’ best interests when faced with clinical dilemmas on the ICU.