Abstract
At a recent General Medical Council conference it was suggested by Dame Janet Smith, author of the Shipman inquiry report, that medical students should be assessed on their understanding of ethical principles (GMC Education Conference, May 9, 2005). Indeed, issues of medical ethics have recently made headline news around the world. In England, the right of a patient with progressive cerebellar ataxia to compel doctors to continued feeding for so long as he wishes is under appeal (Dyer, C. The Guardian, London, May 16th, 2005). In America, the recent death following withdrawal of feeding from Terri Schiavo, who was in a persistent vegetative state since 1990, taxed doctors, legislators and politicians up to the White House (Stolberg, SG, The New York Times, April 1, 2005). While such high profile cases arise exceptionally, critical care routinely involves ethical considerations, either implicitly or explicitly. This review describes various ethical principles commonly employed in relation to critical care, and the common problems with their application in the practice of managing the critically ill patient.