GUIDe (Guidelines for the Use of Intensive Care in Denver): a community effort to define futile and inappropriate care.

Several issues force us to critically evaluate futile or inappropriate intensive care. These issues include cost control, quality of care, and professional and family integrity. The debate has progressed along three avenues: ethical discourse, prognostic scoring systems, and debate in the courts. Despite these arenas of discussion, a consensus about futile or inappropriate care has not been reached. The healthcare profession and the public need to work together to forge a consensus. We describe one model that facilitates this political process. Guidelines for the Use of Intensive Care in Denver (GUIDe) is a consortium of metropolitan Denver hospitals and other healthcare institutions whose goal is to develop guidelines for the use of futile or inappropriate intensive care. The building of consensus starts with subcommittees (adult intensive care, neonatal intensive care, and long-term care) that present proposals at plenary sessions. Other subcommittees (public liaison and legal subcommittees) facilitate dialogue with the public. Feedback from the plenary sessions, the greater medical community, and the public lead to proposal revisions. We expect to present hospitals with actual guidelines in approximately 3 yrs.