Untitled

Abstract

During the past few years the ethics sections of critical care societies have proposed a number of policies describing the goals of intensive care unit (ICU) care and providing broad guidance on the diagnoses and physiological criteria that would mandate using the specialized skill and technologies of an ICU environment. Discussions on what constitutes appropriate use of such scarce resources, incorporating cultural and religious beliefs and exploring how they interact with these medical criteria, remain vague. To date, these policies do not provide any definitive guidance in the difficult decision making faced by clinicians. Some argue that they were never meant to do so and yet they have served to guide the development of local hospital policies. Many have explored how critical care services are allocated without achieving consensus on the best way to achieve fair and equitable access to life-sustaining interventions. A consensus is needed though, one that is reflective of both individual and societal values and goals. Otherwise, increasing pressure to provide treatments with marginal benefits at best will threaten the ability of others to access treatments that may offer them very real benefits.

Practices in Triage and Transfer of Critically Ill Patients: A Qualitative Systematic Review of Selection Criteria

“…Vague wording of ICU triage guidelines such as “likelihood of benefit,” “futility,” or “advanced age” provides practical issues, notably not allowing for measurement of compliance rates ( 142 , 143 ). It also results in unintended externalities such as lack of transparency ( 144 ) or, at least, that of significant physician decision-making variation ( 145 – 153 ).…”

COVID 19: are South African junior doctors prepared for critical care management outside the Intensive Care Unit?

“…In a resource constrained environment, it is required to bear conscience to prioritization of patients. This enables a resource to utilize by more patients and hence provides a greater service to the community as a whole [ 22 ]. When this pandemic passes, the need to equip junior doctors to manage critically ill patients in the emergency department does not end.…”

Better Regulation of End-Of-Life Care: A Call For A Holistic Approach

“…Law is also often not followed with, for example, studies showing some doctors reporting not following advance directives they know to be binding (White et al 2017a;Moore et al 2019;Hardin and Yusufaly 2004). Policies, guidelines, and ethical codes also have limited influence on end-of-life care (Goodridge 2010;Hawryluck 2006). Medical training in end-of-life care does not teach this area well and lacks traction in guiding clinical practice (Parker et al 2015).…”