Introduction: The intensive care unit represents a very stressful clinical environment where life-threatening patients, who are often legally incompetent, are treated. Here, on a daily basis, in acute and highly emotional situations, medical staff make important decisions between the lives and deaths of patients. At this point they may also face an ethical dilemma. Purpose: The purpose of this thesis is to study the most common ethical challenges that arise in the care of patients in the intensive care unit and at the same time play an important role in providing quality care. Methods: A descriptive method with a systematic review of foreign and domestic professional and scientific literature was used. We focused on three main ethical challenges that arise in patient care in the intensive care unit: autonomy, dignity, and discontinuation of treatment. The time frame included literature published between 2011 and 2022, which we searched in the Medline, ScienceDirect and Cinahl databases, in the Pubmed search engine and in the Google Scholar web portal. 9 units of literature were included in the final analysis. Results: The participation of patients in the nursing process is described as conditioned by their state of health and consciousness. Patients in the ICU often experience a loss of control over their lives. During hospitalization, they want to be asked for their opinion, but in case they are unable to communicate, they still want to be informed. Patients feel relieved when they are encouraged by the medical staff to participate in the nursing process and are treated as team members. Unfortunately, there are also situations when they are treated as objects. An example of this situation is patient, being called by their bed unit number. As a major component of ensuring dignity, patients highlighted the provision of intimacy and the provision of health care without signs of disgust and other negative signals showed by medical staff. Appropriate use of humor, fostering real hope, open communication about their diagnosis and prognosis, sense of support from medical staff and being valued as a person helped patients survive through difficult and awkward situations experienced during hospitalization at the ICU. It has been found out that it is ethically and psychologically more difficult for physicians to decide to withdraw than to withold treatment. The most common reasons for withdraw treatment are multiorgan failure and poor prognosis for acute or chronic disease, and the fact that intensive treatment is ineffective for the patient. Withdrawal of treatment most often means the abolition of all active treatment, except analgesic therapy, while the most common form of withhold of treatment is the principle "do not resuscitate". Discussion and conclusion: Patients in the ICU often experience feelings of fear, discomfort and helplessness, mainly due to ignorance of the hospital environment, reduced autonomy of decision-making, lack of information and non-involvement in healthcare. This may lead to patient passivity and consequent dependence on medical staff. The patient must have sufficient information during hospitalization to be able to take an active role and make informed decisions. In order to ensure decent medical care, the medical staff must respect and view the patient as a person, provide him with intimacy and a holistic approach to medical care. In case of a decision to withhold or withdraw life-sustaining treatment it is important to provide the patient with appropriate palliative care, including adequate sedation and analgesia.
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