Making Difficult Decisions in the Intensive Care Unit

By Andrew J. McCormick, MSW, PhD

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For many people, having a family member in the intensive care unit (ICU) can be very difficult. The experience raises concerns about dying and can cause a lot of stress. Throughout the ICU stay, many decisions regarding the patient’s care may have to be made. Often the decisions must be made while dealing with both the shock of seeing a loved one attached to high tech medical equipment and experiencing a range of emotions including loss and fear. This article offers suggestions  for preparing to meet with medical staff members to help individuals and family members make the best decisions they can.

How to Approach Making Decisions in the ICU

One should always understand questions that may need to be answered. There are sometimes critical  decisions to be made in today’s intensive care unit.  Here are a few questions that family members might expect from the ICU staff:

• Did your family member ever talk to you about how much medical care they would want in a situation like this?
• How much should we use artificial life support such as a ventilator (respirator) or feeding tube?
• Should we change the treatment to palliative care to make your family member comfortable and let them die naturally?  (Palliative care or comfort care is treatment that reduces pain and other symptoms rather than providing a cure.)

Get Good Information

Information is vital to good decision-making. Many people are reluctant to ask doctors questions, but those who do get more information. Get support from other family members or your social worker to get your questions answered. Here are some suggested questions:

• What are the immediate goals of the treatment you are proposing?
• What is the long-term outcome of the treatment?
• What has been your experience in this situation with other patients?
• What kind of care is palliative care?
• What is your recommendation?

Also, other family members should be involved. Some family members have a legal authority to make decisions and other family and some friends should be involved because it would be important to the patient.  For example,

• If the patient has a guardian or has signed a durable power of attorney, that person must be part of the decision.  (A durable power of attorney is a legal document that enables an individual to designate another person to act on his/her behalf, even in the event the individual becomes disabled or incapacitated.)
• If the spouse, children and brothers and sisters are available, they are other essential decision makers.
• If the patient has important friends including life partners to whom they are not married, they should also be consulted.

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