One more lesson from a great man! The intensive care ethical dilemma exposed

摘要

Intensive care admission is based on selection which weighs benefits and risks. The decision complexity is paralleling that of today medicine and intensive care. Medically, it is based on the prediction of outcome and a subjective judgement of the current and future quality of life. Beside medical criteria, many ethical, cultural, legal, economic factors play a major role. This opinion article explores the complexity of the decision making and its ethical implications. It's 1963. The twenty-one years old Cambridge student is now diagnosed with a non-curable debilitating neurological disease [1 ]. He is vulnerable to complications and expected to live just for 2 years. From now on, his life will depend on medical care. A new emerging specialty will play a major role: Intensive Care Medicine (ICM). Surprisingly, the expected 2 years turned to be 55. Prediction proved to be wrong but ICM never failed him [2]. Since 1960s, ICM continued to evolve and it's time to apply the acquired cumulative knowledge. Best evidence and experts' opinion had been drafted into protocols and guidelines; all for the sake of patients. Admission and management are becoming increasingly selective and it turned to be "inappropriate" to refer a non-curable with limited life expectancy. "Not for ICU" - the new daily practice-is accepted for its ultimate consequence: death. Ironically, without ICM pioneers treating patients with much higher mortality using much less resources, technology and knowledge, today's Intensive care units (ICU) would never exist [3].