Bench-to-bedside review: Ethical challenges for those in directing roles in critical care units

Though much attention in the medical literature has focused on the ethics of critical care, it seems to be disproportionately weighted toward clinical issues. On the presumption that the operational management of an intensive care unit (ICU) also requires ethical considerations, it would be useful to know what these are. This review undertook to identify what literature exists with regard to the nonclinical issues of ethical importance in the ICU as encountered by clinician - managers. We found that in addition to issues of resource allocation, there exist many areas of ethical importance to clinician - managers in the ICU that have been described only superficially. We argue that a renewed focus on ICU ethics is merited to shed light on these other, non-clinical, issues.