Even physician autonomy, a nearly sacred concept, has to be analyzed in the context of enormous expense and the uncertain outcome of many patients in ICUs. There are various kinds of prognostic scales that have been shown formally to help us make fairly good estimates of ICU patient outcomes. It behooves us for patient welfare, in addition because of cost considerations, to make our care consistent with what we expect. So, if somebody has an extremely poor, nearly hopeless, outcome, it's probably not fair to the patient to offer aggressive, futile care. On the other hand, patients who have a very good predicted outcome, or even an indeterminant outlook, must have every benefit of care.
Individual physicians tend either to underestimate or overestimate the prognosis of patients.
I think the community of physicians needs to become more skilled about what to expect in individual cases. That's a very difficult, complex task, but I don't think you can ignore it. You try to bring to bear the community sentiment by having an open discussion about what happens to patients with specific problems. Families need to be brought into the conversation. In discussing the prognosis and usefulness of therapy with families, sometimes you give information to physicians as well.