Open intensive care units: the case in favour.

Intensive care units traditionally have a closed structure in Italy. They generally have highly restrictive visiting policies, limiting the admission and attendance of family members. This article deals with the issue of open intensive care unit (ICU), i.e. a unit oriented towards the implementation of non-restrictive visiting policies and committed to removing all barriers that have no justifiable necessity, on the level of time, on the physical level and on the level of relationships. The most common objections to opening intensive care units are examined, and the clinical and ethical reasons behind this alternative are considered. As things stand, there is no solid scientific basis for limiting visitors' access to ICUs and keeping ICUs ''closed''. On the contrary, opening ICUs offers a strategy which is to patients' advantage. Opening ICUs should come about not so much in answer to pressure generated by a growing social awareness, or in simple recognition of a right, but because this policy addresses more comprehensively the issue of respect for the patient, as well as providing more appropriate responses to many needs of both patients and families. It is a decision which requires doctors and nurses to rethink their relationships with patients and their families, which calls for original solutions for each individual situation, and which should be subject to periodic checks.