• Alexander A Kon, Eric K Shepard, Nneka O Sederstrom, Sandra M Swoboda, Mary Faith Marshall, Barbara Birriel, and Fred Rincon.
• 1Pediatric Critical Care Medicine and Healthcare Ethics, Naval Medical Center San Diego and University of California San Diego School of Medicine, San Diego, CA.2Anesthesiology and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD.3Center for Ethics, MedStar Washington Hospital Center, Washington, DC.4Department of Surgery, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, MD.5Center for Biomedical Ethics and Humanities, University of Virginia School of Medicine, Charlottesville, VA.6Pennsylvania State University College of Nursing, Hershey, PA.7Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA.
• Crit. Care Med. 2016 Sep 1; 44 (9): 1769-74.

ObjectivesThe Society of Critical Care Medicine and four other major critical care organizations have endorsed a seven-step process to resolve disagreements about potentially inappropriate treatments. The multiorganization statement (entitled: An official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units) provides examples of potentially inappropriate treatments; however, no clear definition is provided. This statement was developed to provide a clear definition of inappropriate interventions in the ICU environment.DesignA subcommittee of the Society of Critical Care Medicine Ethics Committee performed a systematic review of empirical research published in peer-reviewed journals as well as professional organization position statements to generate recommendations. Recommendations approved by consensus of the full Society of Critical Care Medicine Ethics Committees and the Society of Critical Care Medicine Council were included in the statement.Measurements And Main ResultsICU interventions should generally be considered inappropriate when there is no reasonable expectation that the patient will improve sufficiently to survive outside the acute care setting, or when there is no reasonable expectation that the patient's neurologic function will improve sufficiently to allow the patient to perceive the benefits of treatment. This definition should not be considered exhaustive; there will be cases in which life-prolonging interventions may reasonably be considered inappropriate even when the patient would survive outside the acute care setting with sufficient cognitive ability to perceive the benefits of treatment. When patients or surrogate decision makers demand interventions that the clinician believes are potentially inappropriate, the seven-step process presented in the multiorganization statement should be followed. Clinicians should recognize the limits of prognostication when evaluating potential neurologic outcome and terminal cases. At times, it may be appropriate to provide time-limited ICU interventions to patients if doing so furthers the patient's reasonable goals of care. If the patient is experiencing pain or suffering, treatment to relieve pain and suffering is always appropriate.ConclusionsThe Society of Critical Care Medicine supports the seven-step process presented in the multiorganization statement. This statement provides added guidance to clinicians in the ICU environment.

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