A prognostic classification system was developed to help define overall therapeutic goals in critically ill patients with rapidly changing clinical status, in order: a) to force the conscious decision as to use or omission of heroic measures (including cardiopulmonary resuscitation); b) to promote dialogue between the primary physician, ICU staff and the family with respect to the treatment goals and likelihood of success; c) to prevent confusion in those charged with the overall care of the ICU; d) to encourage the development of a treatment plan based on a frequent reassessment of the patient which does not ask the ICU staff to render extraordinary care to a patient who has no reasonable hope for survival as a person; e) to minimize the medical legal risks; f) to dignify the entire ICU operation for the patient, his family, and the staff; and most importantly, g) to guarantee continual reassessment of each individual case with respect to the goals of treatment and the determination of that point in time when treatment should be stopped, when the goals are no longer attainable.