Ethics under pressure: A narrative review of critical care challenges and contem-porary approaches

Critical care medicine involves rapid, high-stakes decision-making that often gives rise to complex ethical dilemmas. These challenges are intensified in low-resource settings such as Ethiopia, where infrastructure, training, and access to services are limited.This narrative review explores four major thematic areas of ethical concern in criti-cal care: resource allocation and triage decisions, end-of-life care, informed con-sent, and equity in service delivery. It examines both traditional ethical frameworks, including the four principles approach, deontology, and virtue ethics, and contem-porary approaches such as narrative ethics, relational autonomy, and ethics consul-tation services. Cultural values, system limitations, and communication gaps are an-alyzed with specific reference to the Ethiopian context.By synthesizing international literature with low-income country realities, the re-view highlights the urgent need for contextualized ethical guidelines, expanded eth-ics education, and institutional support mechanisms. Strengthening ethical capacity in critical care is essential to ensure compassionate, fair, and patient-centered care delivery in both high- and low-resource settings.