Ethical Principles in Critical Care

THE MOST compelling principle of medical ethics always has beenbeneficence: acting to benefit patients by sustaining life, treating illness, and relieving pain. A correlative principle isnonmaleficence: refraining from harm. A third principle that has increasingly gained acceptance in the United States isautonomy: respecting the right of patients to determine much of their medical care. Closely related to this isdisclosure: providing adequate and truthful information for competent patients to make medical decisions.¹⁻³A fifth ethical principle issocial justice: allocating medical resources fairly and according to medical need.⁴ The first four ethical principles outlined above are the foundation of the fiduciary relationship in which physicians are expected to serve the best interests of their patients as the patients define these interests. This relationship is relatively easy to maintain when primary physicians follow up patients in their offices or in hospital rooms. However, the relationship may