Approaching ethical issues in critical care units--whose decision is it anyway?

In upholding the patient's interests it is important for intensive care practitioners (nurses and doctors) to distinguish between judgements of fact and judgments of value when making important clinical decisions, and further, not to overstep their authority as health care providers when caring for seriously ill patients. If moral errors and harm are to be avoided in intensive care units it is imperative that not only nurses and other members of the intensive care team are educationally prepared to deal with the complex moral problems posed by intensive care practices, but that the role of the patient (or her/his self-chosen representative) in decision making is fully expanded. In this respect, it is not merely the patient's so-called 'good' which nurses and other health workers must strive to maximise, but also the patients' preferences. In this paper, brief attention will be given to: [1] examining the nature of ethical decisions and the ways in which these differ significantly from clinical medical/nursing and legal decisions; and [2] exploring ways in which nurses (and other members of the intensive care team) can better ensure the realisation of morally just outcomes for patient's requiring intensive care.