HARD DECISIONS IN INTENSIVE CARE UNIT

Intensivecareunitkapak

ETHICS AND DECISION MAKING PROCESSES

Seval Kılbasanlı

Ömer Halisdemir University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Niğde, Türkiye

Kılbasanlı S. Ethics and Decision Making Processes. In: Turan S, editor. Hard Decisions in Intensive Care Unit. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.553-560.

ABSTRACT

Intensive care units are one of the healthcare settings where ethically complex decisions are frequently encountered. Issues such as end-of-life care, equitable distribution of resources, patient autonomy, and patient-family expectations form the basis of ethical dilemmas in intensive care. This chapter discusses ethical decision-making processes in intensive care through basic ethical principles and solutions.

Ethical decision-making processes are based on four fundamental principles: autonomy, beneficence, nonmaleficence, and justice. Autonomy refers to the right of patients to make their own health decisions. However, this principle is difficult to apply in intensive care because the patient is unconscious or incapable of making decisions. The principle of beneficence aims at patient recovery, while the principle of nonmaleficence requires healthcare professionals to avoid unnecessary or harmful treatments. The principle of justice ensures the fair distribution of limited resources and is supported by prioritization systems in crises.

A multidisciplinary approach is important in ethical decision-making processes in intensive care. Teams of doctors, nurses, social workers, and ethics consultants provide more balanced decision-making. In addition, ethics committees provide guidance and impartial assessments to healthcare professionals in complex situations. Ethical guidelines and protocols standardize decision-making processes, while case studies help workers make more informed decisions when faced with similar ethical dilemmas.

Cultural and religious factors can be decisive in ethical decision-making processes. Sensitiveness to the patient’s cultural and individual values strengthens the patient-family relationship. Cultural awareness training for healthcare professionals plays an important role in preventing ethical conflicts. In addition, technological solutions such as digital decision support systems can provide speed and efficiency in decision-making processes.

In conclusion, providing ethical guidance in intensive care improves the quality of patient care and contributes to healthcare professionals’ fulfillment of ethical responsibilities. Strategies such as continuous education, guideline updates, and ethics committee consultation are recommended to increase the effectiveness of these processes.

Keywords: Intensive care; Ethical decision-making; Multidisciplinary approach; Patient autonomy; Ethics committee; Ethical guideline

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