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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
TOWARDS AN ETHICAL MANAGEMENT OF INTENSIVE CARE SMART 2002 Milan, May 29-31, 2002
Minerva Anestesiologica 2002 April;68(4):214-8
Principles, protocols and patients: the practical management of a limit in ICU
Zamperetti N., Carraro R., Marafon S., Abbate A., Lieta E., Piccinni P., Dan M.
From the Department of Anesthesia and Intensive Care Medicine San Bortolo Hospital, Vicenza (Italy)
The definition and management of a limit is a common but sometimes extremely complex problem in the Intensive Care Unit (ICU). Guidelines and consensus documents have been published in order to help clinicians. Yet, many controversial issues are brought into question. Legal rules are sometimes vague and derive more from the interpretation of various and unrelated principles (which vary from country to country) than from a clear “ad hoc” law. In this sense, the practical management of a limit in ICU is usually run by a dual normativity: an external one, which derives from the cultural, moral and legal values of the society, and an internal one, which depends on the particular clinical and human situation, namely the values of everybody involved in (the patient, his/her relatives, the health staff) and the relationships among these people. The considerable freedom left for the decision by an open communication is a great and favourable potential which must be used in the interest of the patient’s and of his/her family.