Ethical Decision-Making Frameworks in Intensive Care Medicine

Abstract

Making decisions that are ethical is a characteristic aspect of intensive care medicine, in which practitioners constantly face high-stakes decisions involving life-sustaining interventions, resource utilisation, end-of-life care, and patient autonomy. Prognostic uncertainty, the technological ability to extend the lifespan, family suffering, and the ethical strain on care providers help to increase the difficulty of these choices. The article is the critical analysis of the ethical decision-making frameworks in the field of intensive care medicine that has combined theoretical models, empirical evidence and practical ethical guidances in adult, neonatal, paediatric and emergency critical care settings. Basing on the existing bioethical principles, shared decision-making models, communicative ethics, and crisis-based allocation frameworks, the review presents the impact of ethical climates, time pressure, moral distress, and sociocultural factors on the decision process in the intensive care units (ICUs). Ethical issues in the times of population health emergencies, end-of-life decision-making, and incorporation of palliative care principles are given special attention. New forces of digital health, artificial intelligence and psychosocial determinants of ethical decision-making are also addressed. The article indicates that ethically sound ICU practise should have organised structures, interdisciplinary teamwork, effective communication, and institutional resources to facilitate morally sustainable care.

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