Application of a model to guide ethical decision making in burn treatment.

Ethical considerations in the decision to resuscitate and continue treatment of a massive burn injury are complex. As survival improves, the parameters we use in deciding to resuscitate are less clear. The point at which further treatment is futile is often difficult to recognize, and the decision-making process of whether to withhold or withdraw care can cause great anxiety for the family, as well as for the burn team. The identification of the operative ethical principles in this decision-making process helps clarify issues and values. Although there is no simple algorithm for decision making with ethical dilemmas, the systematic application of the decision-making model presented here that consists of 4 prioritized questions that address medical indications, patient preferences, quality-of-life issues, and contextual factors can focus the problem and define options. In addition, early use of a hospital bioethics committee is advocated to resolve conflict and to provide an acceptable forum for discussion.