Bioethics Blogs

Comments on the New ATS/AACN/ACCP/ESICM/SCCM Statement: Responding to Requests for Potentially Inappropriate Therapies in the ICU

In the late January MEDICAL ETHICS ADVISOR, Baylor College of Medicine Professor Janet Malek comments on the new “Official ATS / AACN / ACCP / ESICM / SCCM Statement: Responding to requests for potentially inappropriate therapies in the ICU.”

“While this may allow for more semantically coherent dialogue on this topic, it does not give additional guidance about which treatments should not be offered by providers.”

Instead, Malek says it raises a new set of questions: 

  • What interventions are inappropriate? 
  • Under what circumstances are they inappropriate? 
  • Why are they considered to be inappropriate? 
  • Who determines whether they are inappropriate?

“The approach advocated by the policy only answers the last of these questions.” The policy statement  proposes a process-oriented, step-wise approach involving a second opinion, hospital review, and facilitation of transfer to another institution before permitting life-sustaining treatment to be withheld. “The process therefore draws on a progressively wider set of opinions about whether an intervention is inappropriate, without defining the concept itself.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.