Ethical Issues in the Postoperative Intensive Care Unit

Abstract

Ethical principles are the foundation of the practice of medicine. The intensive care unit (ICU) has always been a fertile ground for ethical dilemmas and today is further impacted by many conflicting forces, including the emphasis on patient autonomy, the medical eco nomic climate and the rise of managed care, and the wide availability of life-extending technologies. This article will address three specific ethical concerns that are particularly seen in the ICU to help physicians clarify the ethical issues present in their day-to-day practice. Advance directives were developed in an attempt to make the area of end-of-life decision-making less com plex and more responsive to patient autonomy, but the uses and limitations of these documents must be under stood to use them most effectively. Futility is a signifi cant concern as lives are extended by recent medical advances and technology. The question then becomes, when is it appropriate to withdraw these therapies, and how then to proceed in a caring and ethical manner. Finally, as patients begin to use advance directives more frequently, there will be more cases of patients with preexisting Do Not Resuscitate (DNR) orders com ing to the operating room for surgery for an unrelated disease or palliative procedures. The conduct of care in these cases needs to be based on a well-understood ethical framework.