Critical care

Abstract

The support of vital organ functions is the basis of modern critical care. Life-sustaining therapy is always provided in the initial belief that the patient will recover and the support provided will be withdrawn. The provision of invasive and potentially harmful therapeutic interventions such as mechanical ventilation, renal replacement therapy, inotropic support, etc. is consistent with two principles that guide the practice of medicine: preserving life and alleviating suffering. However, frequently it comes to pass that the physician believes that if the patient survives his or her quality of life will be unacceptably poor, and thus a conflict between those two principles develops.13 At this point the question arises as to whether interventions should be either withheld or withdrawn, with death being the inevitable outcome. What is the appropriate course of action? The problem is compounded by the disparity of opinion among different providers faced with the problem.