Ethics
Ethics tests consent and capacity, end-of-life decisions, resource allocation and research conduct in intensive care.
Core rules
- Four principles: autonomy, beneficence, non-maleficence and justice.
- Capacity requires understanding, retention, weighing and communication. If capacity is absent, act in best interests, considering advance directives and surrogate views.
- DNACPR is a treatment decision and communication process, not a substitute for discussing overall goals of care.
- Withdrawal of life-sustaining treatment follows the same ethical framework as withholding it. Sedation and analgesia titrated to comfort are acceptable.
- Research requires informed consent, ethics approval, proportionality of risk and safeguards for emergency research.
Worked example
A ventilated patient with severe hypoxic brain injury lacks capacity and has no advance directive. The team documents that ongoing organ support offers no meaningful recovery, involves the family, and agrees to withdraw ventilation while providing comfort care. The decision is made in the patient's best interests, not solely by family vote.
Traps
- Assuming family consent is legally required for every withdrawal; jurisdiction varies.
- Withholding analgesia because of fears of hastening death.
- Treating futility as a purely medical certainty rather than a value-laden judgement.
- Ignoring conscientious objection and second opinions.