George is dying. Cancer will eventually claim his life, and that moment looms close. How close? Could the proposed plan of care see George through the immediate crisis? If so, are we just buying time? If not, are we just compounding George’s suffering? Is this the best use of critical care resources and expertise?

As a patient’s illness worsens, the critical care response becomes more aggressive in order to regulate or replace failing physiologic functions. Clinicians may feel caught on an increasingly slippery slope. It seems as though the patient for whom we have a duty to care is being exposed to greater burdens without a reasonable expectation of receiving the benefits that therapies are intended to provide. Core ethical principles of non-maleficence, beneficence, and justice seem to be compromised. A natural and appropriate response under such circumstances is to inquire, “Why are...

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