An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate...

Area of Science:

• Medical Ethics
• Critical Care Medicine
• Healthcare Policy

Background:

• Controversy exists regarding patient or surrogate requests for treatments clinicians deem inappropriate.
• Managing these requests in intensive care units (ICUs) presents ethical challenges.

Purpose of the Study:

• To provide recommendations for preventing and managing intractable disagreements about treatments in ICUs.
• To offer guidance for clinicians facing complex end-of-life care decisions.

Main Methods:

• Developed through an iterative consensus process involving multiple professional societies.
• Included expert committee development and peer review by designated committees.

Main Results:

• Recommends proactive strategies to prevent treatment conflicts, such as early consultant involvement.
• Advocates for using "potentially inappropriate" over "futile" to describe treatments with ethical conflicts.
• Outlines a conflict resolution process for intractable disagreements, including hospital review and external review options.
• Suggests restricting "futile" to interventions that cannot achieve their physiologic goal.
• Emphasizes the medical profession's role in public engagement and policy advocacy regarding life-prolonging technologies.

Conclusions:

• This multisociety statement offers crucial guidance for clinicians.
• Aims to improve the management of disputes concerning potentially inappropriate treatments in critically ill patients.