Withdrawing and withholding treatment in intensive care. Part 2. Patient assessment.

In order to allocate resources fairly in intensive care units, and to avoid treatment which only prolongs dying, accurate prediction of outcome is necessary. Most systems that have been developed to predict the outcome of treatment are flawed and are little better than the guesses of experienced medical and nursing staff. The likelihood of survival must then be weighed against a subjective assessment of quality of life. The perception that intensive care wastes resources on patients who have little chance of survival should be reassessed in the light of our limited ability to detect hopelessly ill patients before embarking upon treatment.