Ethical issues in the critically ill patient

Ethical issues have emerged in recent years as a significant component of care in the critically ill patient. Recently, the primary emphasis has been directed to care at the end-of-life. The factor that has been identified as the most important to patients and families and the one that is accomplished the least often is successful communication with the physicians. When communication does not take place or is inadequate physicians are left to try to determine what their patient's wishes would have been regarding end-of-life decisions. This leads to tremendous potential for conflict between the physician and the family, as the patients are often incapable of participating in any discussion regarding end-of-life care. Advance planning on the part of the patient in terms of making their wishes known and education of the health care professionals is essential in promoting effective communication, thereby avoiding conflict in these difficult end-of-life decisions.