[Ethical conflicts in the surgical intensive care setting - impact of ethics consultations]

In surgical intensive care medicine an increase in ethical conflicts regarding treatment plans has been observed due to marked changes in medical possibilities and social epidemiology resulting in intensive care treatment of old and oldest patients following surgery, trauma or transplantation. Without ethical support, physicians, nurses, and families are not able to come to a decision about medical treatment when value conflicts are involved.

We present a report on the basis of medical ethics and personal experience and provide an overview on the impact of ethics consultations.

Ethical conflicts are common in the surgical intensive care setting, since the patient's preferences often are not known exactly, and in modern "high-tech" intensive care medicine the prognosis of recovery and / or quality of life of (old) patients seems to be hard to assess. Ethical definitions of treatment perspectives will find an important and increasing place in intensive care competence in the future, although nowadays there is a lack of theoretical and practical instruction in ethics. The goal of ethics consultations is to help physicians, nurses and family members by structuring the problem and by a moderation of discussion and problem resolution including a special "ethical workflow". Ethics consultations seem to be useful in resolving conflicts that may inappropriately prolong unwanted treatments.

The incidence of ethical conflicts increases even in surgical intensive care units and ethics consultations may help in the integration of ethics principles in clinical practice.