Ethics in the intensive care unit with emphasis on medical futility in comatose survivors of cardiac arrest.

Medical futility refers to situations or cases in which treatment offers no meaningful benefit to the patient. Brain death does not pose a management problem because patients are considered to be dead. Management of other cases requires sequential considerations. First, the prognosis must be established with certainty. Then, if it is determined that there is no possibility of the patient regaining conscious awareness, a level of care should be decided through discussions involving the physician and significant others. Usually there is a consensus that high-level intensive care is not justified to maintain such a low quality of life. When the patient's advance directives or the substitute decision maker's request differs from the physician's recommendations, there are methods of resolving the issues that respect ethical and legal principles.