End-of-life ethical dilemmas in intensive care unit

Sustaining vital functions in critically ill in the ICU frequently allows prolongation of patient’s life even in circumstances where the treatment has lost its medical rationale and/or there is no hope for the patient’s condition to improve. Decision-making about termination of such treatment – usually referred to as futile, useless or inappropriate –, frequently presents a difficult ethical dilemma not only for the intensivists and other health-care workers but also for the patients and their relatives. The principles of biomedical ethics present a useful framework for decision-making in ethical dilemmas but cannot offer sufficiently explicit guidelines. Besides, the concepts of futility or futile treatment in the ICU are also not unequivocally defined. Thus, the decision regarding continuing or stopping treatment should be based on careful evaluation of the balance between its expected efficiency and benefits on the one hand and the burden imposed upon the patient on the other. If the burden clearly exceeds the expected benefits, the ethically sound decision is to terminate such treatment.