• Diana Spoljar, Marko Curkovic, Chris Gastmans, Bert Gordijn, Dina Vrkic, Ana Jozepovic, Suzana Vuletic, Dinko Tonkovic, and Ana Borovecki.
• University Hospital Dubrava, School of Medicine, University of Zagreb, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia. Electronic address: dspoljar@kbd.hr.
• J Crit Care. 2020 Aug 1; 58: 10-19.

PurposeIntensive care unit health care professionals must be skilled in providing end-of-life care. Crucial in this kind of care is end-of-life decision-making, which is a complex process involving a variety of stakeholders and requiring adequate justification. The aim of this systematic review is to analyse papers tackling ethical issues in relation to end-of-life decision-making in intensive care units. It explores the ethical positions, arguments and principles.MethodsA literature search was conducted in bibliographic databases and grey literature sources for the time period from 1990 to 2019. The constant comparative method was used for qualitative analysis of included papers in order to identify ethical content including ethical positions, ethical arguments, and ethical principles used in decision-making process.ResultsIn the 15 included papers we have identified a total of 43 ethical positions. Ten positions were identified as substantive, 33 as procedural. Twelve different ethical principles emerged from the ethical arguments. The most frequently used principles are the principles of beneficence, autonomy and nonmaleficence.ConclusionsWe have demonstrated that recommendations and guidelines designed specifically by intensive or critical care experts for intensive care units promote similar ethical positions, with minimal dissenting positions.Copyright © 2020 Elsevier Inc. All rights reserved.

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