• T Bein.
• Klinik für Anästhesiologie,Universität Heidelberg, Deutschland. thomas.bein@klinik.uni-regensburg.de
• Anaesthesist. 2012 Jan 1;61(1):6-13.

IntroductionAn increase in ethical conflicts is being observed in the modern intensive care setting, as more complex therapeutic strategies are available and the treatment of old and very old patients is integrated into the clinical routine due to changes in medical options and social epidemiology. Physicians, nurses and families need ethical support to come to a decision about medical treatment when value conflicts are involved.MethodsThe basis of medical ethics is reported followed by a presentation of personal experiences and a reference overview regarding the impact of ethics consultations.ResultsCommon ethical conflicts in the intensive care setting result from the lack of precise knowledge on patient preferences and due the use of modern "high-tech" intensive care medicine the prognosis of recovery and quality of life of (old) patients seems to be difficult to assess. Ethical definitions of treatment perspectives will find an important and increasing place in intensive care competence in the future, although currently 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 a structuration of 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 treatment.ConclusionsThe increase of the incidence of ethical conflicts in the intensive care setting may impact ethics consultations which help the integration of ethical principles into the clinical practice.

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