Ethical issues in the chronically critically ill patient

The chronically critically ill are a growing population of patients with unique medical and ethical problems. Despite aggressive and high technology care used to treat these patients, their outcomes seem to be poor. Understanding decision making in the face of this conflict requires knowledge of ethical principles that influence the thought process of the physician and patient. The principles of autonomy, justice, and futility are central to decision making in the chronically critically ill. Although there is much to learn about this population, the physician can provide essential direction to the patient in the process of making difficult decisions.