Guidelines for deciding care of critically ill or dying patients.

Medical technology is usually beneficial in the care of sick or injured persons, sometimes dramatically so. However, since it is often intrusive, occasionally cruel, sometimes of little or no value, and almost always expensive, its use must be assessed critically, particularly in ICUs. Guidelines for doing this are proposed. To ensure the most caring approach to patient care and family support, the values and autonomy of patients and their families, one by one, are emphasized in all decision making and the roles of nurses and social workers as well as those of physicians are considered central. If these guidelines are used, many, perhaps most, of the ethical and legal issues and the problems of human relationships in ICUs will be resolved.