Abstract

This article addresses a common yet rarely discussed aspect of hospital care—a pro-active approach to ethical dilemmas. Potential ethical conflicts often present warning signs to clinicians, analogous to the warning lights on a car’s dashboard. Using a recent case study, a commonly encountered clinical decision—a conflict about whether to terminally extubate a critically ill patient versus whether to offer a tracheostomy— we describe a pro-active approach to ethical conflicts and outline three learning objectives: (1) the need for a robust understanding of the term “futility,” (2) the need for an appreciation of the various and often conflicting interpretations of “improved/improving,” and (3) the need to understand the challenges of surrogate decision making.