title: An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units.
abstract: BACKGROUND
  There is controversy about how to manage requests by patients or surrogates for treatments that clinicians believe should not be administered.
  
  
  OBJECTIVE
  This multisociety statement provides recommendations to prevent and manage intractable disagreements about the use of such treatments in intensive care units.
  
  
  METHODS
  The recommendations were developed using an iterative consensus process, including expert committee development and peer review by designated committees of each of the participating professional societies (American Thoracic Society, American Association for Critical Care Nurses, American College of Chest Physicians, European Society for Intensive Care Medicine, and Society of Critical Care).
  
  
  RESULTS
  The committee recommends: (1) Institutions should implement strategies to prevent intractable treatment conflicts, including proactive communication and early involvement of expert consultants. (2) The term "potentially inappropriate" should be used, rather than futile, to describe treatments that have at least some chance of accomplishing the effect sought by the patient, but clinicians believe that competing ethical considerations justify not providing them. Clinicians should explain and advocate for the treatment plan they believe is appropriate. Conflicts regarding potentially inappropriate treatments that remain intractable despite intensive communication and negotiation should be managed by a fair process of conflict resolution; this process should include hospital review, attempts to find a willing provider at another institution, and opportunity for external review of decisions. When time pressures make it infeasible to complete all steps of the conflict-resolution process and clinicians have a high degree of certainty that the requested treatment is outside accepted practice, they should seek procedural oversight to the extent allowed by the clinical situation and need not provide the requested treatment. (3) Use of the term "futile" should be restricted to the rare situations in which surrogates request interventions that simply cannot accomplish their intended physiologic goal. Clinicians should not provide futile interventions. (4) The medical profession should lead public engagement efforts and advocate for policies and legislation about when life-prolonging technologies should not be used.
  
  
  CONCLUSIONS
  The multisociety statement on responding to requests for potentially inappropriate treatments in intensive care units provides guidance for clinicians to prevent and manage disputes in patients with advanced critical illness.
authors.forename: Gabriel T
authors.initials: GT
authors.lastname: Bosslet
authors.forename: Thaddeus M
authors.initials: TM
authors.lastname: Pope
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Rubenfeld
authors.forename: Bernard
authors.initials: B
authors.lastname: Lo
authors.forename: Robert D
authors.initials: RD
authors.lastname: Truog
authors.forename: Cynda H
authors.initials: CH
authors.lastname: Rushton
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.forename: Dee W
authors.initials: DW
authors.lastname: Ford
authors.forename: Molly
authors.initials: M
authors.lastname: Osborne
authors.forename: Cheryl
authors.initials: C
authors.lastname: Misak
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Baruch
authors.initials: B
authors.lastname: Brody
authors.forename: Brenda G
authors.initials: BG
authors.lastname: Fahy
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Hall
authors.forename: Jozef
authors.initials: J
authors.lastname: Kesecioglu
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Kon
authors.forename: Kathleen O
authors.initials: KO
authors.lastname: Lindell
authors.forename: Douglas B
authors.initials: DB
authors.lastname: White
mesh_terms: D003422:Critical Care / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D012955:Societies, Medical; D019564:Unnecessary Procedures / Q000592:standards*
keywords: conflict resolution; end-of-life care; ethics committees; futility; shared decision making