Ethical and Clinical Aspects of Intensive Care Unit Admission in Patients with Hematological Malignancies: Guidelines of the Ethics Commission of the French Society of Hematology

Table 1

Multistep decision-making approach.

Before initiating any high-risk treatment	Possibility of a transfer to ICU should be discussed
As soon as a clinical distress appears	Intensivists must be consulted; they should participate in the early detection of critical states.
Transfer to ICU	Decision must arise from an interdisciplinary concertation between intensivists and hematologists.; The need to document patient preferences is crucial.
Decision of nontransfer to ICU	Falls within the general context of limitations of treatments in hematology. Palliative care is required to guarantee end-of-life quality.; The views of intensivists can be sought to help in symptom control.
3 to 5 days after admission to ICU	Concerted reevaluation must be programmed, especially in case of an ICU trial.; Need to decide whether to maintain the same intensity of life-sustaining therapies or to consider withdrawal.
During stay in ICU	Hematologists have to visit regularly their patients in ICU and should take part actively in the decision to maintain the patient in ICU.
Regular scheduled multidisciplinary meetings	The objective is to discuss clinical situations involving intensivists and hematologists. It should be open to palliative care specialists and psychologists. The aim is to identify areas of improvement.
In case of limitation or withdrawal of active treatments	Collegial concertation has to be maintained to initiate palliative care and patient accompaniment and to provide the appropriate support to the relatives. At this stage, a transfer back to hematology can be discussed.