Some ethical principles for adult critical care.

State of the art in approaching several of the most disturbing problems involving end-of-life decision-making in an intensive care setting is applicable to other contexts as well. Developed as part of the curriculum at the John A. Burns School of Medicine at the University of Hawaii, the material is intended as a reflection of current work in health care ethics, strongly supported by literature, and generally consistent with current legal trends. But it also has developed into something of a consensus document, having been widely circulated in various versions, repeatedly presented to professional audiences dozens of times in Hawaii, and improved by countless comments and suggestions. The focus here is on the standards for withholding and withdrawing treatment. It should be noted that some important types of ethical problems are not covered: In particular, scarce resource problems (including some related questions involving medical futility), maternal-fetal and pediatric issues, and questions involving the notification of potentially affected third parties.