Ethical considerations in the use of neuromuscular blockades

The long-term use of neuromuscular blocking agents in the adult intensive care unit is clinically and ethically challenging. These drugs can be dramatically lifesaving; they also have the potential of causing the patient great emotional, spiritual, and physical harm. Traditional ethical analysis is important but may not be adequate. Rigorous attention should be given to risk-benefit ratios, informed consent, and quality of life. It is suggested that institutions develop written consent forms and information sheets, use adapted values history forms in assessing treatment decisions and quality of life, and fully utilize ethics committees and patient care conferences in caring for these catastrophically ill patients.