The rapidly evolving landscape of hospital-based intensive care in the United States raises difficult ethical questions about whether, and under what circumstances, clinicians and hospitals may justifiably initiate, withhold, or withdraw life-sustaining medical treatment (LSMT) over the preferences of patients or surrogates. Taking measures counter to patient and surrogate preferences regarding LSMTs that clinicians perceive to be "potentially inappropriate," "disproportionately harmful," or "nonbeneficial" may have lasting consequences not only for patients and families but also for the nurses and other clinicians who care for them. In 2015, a multisociety policy statement was published to help guide management of intractable conflicts around LSMTs between patients or surrogates and the clinicians overseeing their care. The statement defines potentially inappropriate treatments as those that have "at least some chance of accomplishing the effect sought by the patient, but clinicians believe that competing ethical considerations justify not providing them." Authors of the policy recommended a 7-step dispute resolution process for managing associated conflicts. Although it offered a few illustrative case scenarios, it did not otherwise delineate which competing ethical considerations should be taken into account or how much weight each ought to carry.
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