Bioethics Blogs

ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research

A SCCM task force has just published, in the September 2016 Critical Care Medicine, updated guidelines for ICU admission, discharge, and triage.  

In addition to those three topics, the guidelines also include six pages on “Nonbeneficial treatment (futile care) in the ICU.” The authors make good basic points in terminology, prevalence, prognostic scoring, CPR, brain death, ethics consults, and palliative care.

Specific recommendations include:

  • We suggest employing the term “nonbeneficial treatment” whenever clinicians consider further care “futile”
  • We suggest avoiding the current quantitative definitions of nonbeneficial treatment because of the lack of consensus on a single definition
  • We suggest against the routine use of the currently available severity-of-illness scores for identifying nonbeneficial treatments in specific patients
  • We suggest that the information provided by healthcare professionals be quantitative to reduce disagreement between the prognostic information delivered to the patients’ surrogates and their understanding and acceptance of the message
  • We suggest developing clear ICU and institutional nonbeneficial treatment policies through consensus of all the parties involved (physicians, nurses, administrators, lawyers, ethicists, and family representatives)
  • We suggest that prudent clinical judgment, in conjunction with the latest American Heart Association guidelines and specific local and hospital policies, be followed in deciding when to withhold or terminate cardiopulmonary resuscitation
  • We suggest that life-supportive therapies be removed in cases of patients declared dead by neurological criteria in accordance with local law (including potential legal restrictions associated with the patient’s religious beliefs), hospital policies, and standard medical practice and after appropriate organ donation considerations
  • We suggest the early involvement of ethicists (within 24 hr of identifying potential or actual conflict) to aid in conflicts associated with nonbeneficial treatment
  • Although palliative medicine consultations have been previously associated with reduction in critical care resources, the most recent evidence does not support a recommendation, emphasizing the need for additional high-quality research on this subject
  • We suggest following the SCCM Ethics Committee’s 1997 general recommendations for determining when treatments are nonbeneficial and for resolving end-of-life conflicts regarding withholding or withdrawing life support.

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.