Ethics and palliative care consultation in the intensive care unit

It is clear that ethics and palliative care consultation have, in our view, much to offer intensivists as they attempt to work through the very complex and often tragic cases they face in their daily practice. Potential strengths include clarification of tangled normative issues, facilitation of shared decision making, conflict resolution, and expertise in the provision of comfort care. Despite this, it is an unfortunate fact that many intensivists remain reluctant to use ethics and palliative care services. There are, of course, many possible reasons for this, including the absence of quality services in certain institutions, issues, or power and control, and role misperceptions. It is our hope that we have helped to clarify appropriate roles for ethics and palliative care in the intensive care unit. We urge the continued development of quality ethics and palliative care services, and the use of those services by intensivists.