New medical and technological developments broaden the therapeutic armamentarium of the modern physician. At the same time, patients are often better informed than only a decade ago, and sometimes they pose unrealistic demands onto the health care teams and the health care system. Which treatments are at hand in a specific situation? And if at hand, do they need to be offered regardless of their possible benefits or costs? Or regardless of a patient’s wish?

Ethical dilemmas can and do arise in daily health care practice. Within medicine, critical care is an area where issues regarding autonomy, beneficence, possible harm and distributive justice commonly highlight ethical problems that the patients, their families and the critical care team need to deal with. The module “Ethics” does not attempt to provide answers to all the difficult questions, nor will it master all potential dilemmas, but it will point out some ways in which ethical issues in critical care can be addressed, clarified and hopefully solved.

Many critically care patients are too ill to discuss their goals of care or give their consent to treatment. It is often necessary to find a way to make difficult decisions, which may involve the initiation or the foregoing of intensive life-sustaining therapies, on a patient’s behalf. This module outlines approaches that respect the autonomy of the patient in reaching therapeutic decisions, for example with the help of surrogate decision makers, as well as the modern concept of shared-decision-making.

Intensive care technology has given practitioners the ability to sustain the body’s metabolic processes even when recovery to independent existence becomes impossible. Reasoning about potentially inappropriate treatment is an important ethical task. Where the line between doing good and causing unintended harm becomes very narrow, changing the goal of treatment from cure to comfort is often inevitable. The module discusses this often difficult process, including concepts such as “active shortening of the dying process” and “euthanasia” – which are frequently misunderstood and misused terms. The complexity and invasiveness of intensive care treatments may not only cause unintended harms to our patients; but together with poor working environments, may lead to medical errors and staff burnout. Problems that need to be addressed properly.

The rise in cultural diversity due to immigration is leading to new ethical dilemmas. The values of professionals, patients and families might not align, when they come from different backgrounds. In modern societies, it is no longer obvious that the views of the professionals are leading the way, yet medical care should not abandon its core ethical values.

Beyond the individual doctor-patient relationship, there is a valid public interest in the work physicians do. Some of the issues of public concern will be explored. Research involving critically ill patients poses an extra ethical challenge. The difficulties in obtaining consent, the often very small time windows in emergency research and the balance between potential benefit and harm is addressed in the final chapter of this module.