Abstract and Introduction
Abstract
Decisions to limit life-sustaining therapy occur often in the critical care setting. Bioethical dilemmas may occur as decisions are made to withhold and/or withdraw life-sustaining therapy. Even when the decision to limit life-sustaining therapy is ethically appropriate and clear, there can be issues. A case will be presented to illustrate dilemmas that can arise as these difficult decisions are made. The following bioethical issues will be discussed: (1) When is it ethical to limit life-sustaining therapy? (2) Who should make decisions when a patient is unable to make his/her own decision? (3) What should be done if a patient's previously stated wishes are not honored? (4) What should be done if a patient is suffering? It is essential that bioethical issues are identified and addressed.
Introduction
Of those patients who die in the intensive care unit (ICU), most do so after decisions are made to limit life-sustaining therapies (LSTs). Withholding or deciding not to initiate LST may include decisions not to perform cardiopulmonary resuscitation (CPR) if an individual's heart stops or not to start renal dialysis if a person's kidneys fail. Decisions to withdraw or remove LST may include decisions to stop mechanical ventilation, vasopressor therapy, and a ventricular cardiac assist device or deactivate an implanted cardioverter defibrillator. Ethical dilemmas may occur as these sensitive, complex decisions are made and during the process of limiting LSTs. Even when the decision to withhold or withdraw LSTs is ethically appropriate and clear, there can be issues. The following case will illustrate some of them.