Ethical content of expert recommendations for end -of -life decision -making in intensive care units: A systematic review

Purpose: Intensive care unit health care professionals must be skilled in providing end -of -life care. Crucial in this kind of care is end -of -life decision -making, which is a complex process involving a variety of stakeholders and requiring adequate justi fication. The aim of this systematic review is to analyse papers tackling ethical issues in relation to end -of -life decision -making in intensive care units. It explores the ethical positions, arguments and principles. Methods: A literature search was conducted in bibliographic databases and grey literature sources for the time period from 1990 to 2019. The constant comparative method was used for qualitative analysis of included papers in order to identify ethical content including ethical positions, ethical arguments, and ethical principles used in decision -making process. Results: In the 15 included papers we have identi fied a total of 43 ethical positions. Ten positions were identi fied as substantive, 33 as procedural. Twelve different ethical principles emerged from the ethical arguments. The most frequently used principles are the principles of bene ficence, autonomy and nonmale ficence. Conclusions: We have demonstrated that recommendations and guidelines designed speci fically by intensive or critical care experts for intensive care units promote similar ethical positions, with minimal dissenting positions. ? 2020 Elsevier Inc. All rights reserved.