Clinical ethics consultation in the intensive care unit

Picozzi, Mario; Gasparetto, Alessandra

doi:10.23736/s0375-9393.20.14028-8

Cited by 11 publications

(9 citation statements)

References 49 publications

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“…A common denominator in all these differences of opinion was that all would benefit from training, which helps professionals to better understand the technical phenomena and the dialogical methods involved in the decision-making process. And in this educational process, as indicated both by respondents to this survey and in previous studies, the clinical ethicist should play an important role [ 7 , 17 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 94%

“…The conflicts between the care team and the family or between the members of the family itself 9 (4) j. The differences in diagnostic, therapeutic and prognostic opinions among colleagues 32 (17) k. The decision to admit a patient to the ICU considering that the resources are not infinite 30 ( 16) c. With all the professionals involved in the care of that patient 16 (22) d. With the healthcare team and, if necessary, also with family members and, where possible, with the patient 56 (77) Most ICU staff members were of the opinion that the clinical ethicist should help all the involved parties in a clinical case in making a shared ethical decision but should not be a "final judge" [5] of ethical disputes in a clinical setting. A considerable number of ICU staff members identified the clinical ethicist as a valid collaborator in the field of training, updating, and drafting operating procedures, testifying to the fact that the staff feel an important need for training in this area.…”

Section: Discussionmentioning

confidence: 99%

“…The "Clinical Ethics Consultation in the Intensive Care Unit" (Consulenza Etica in Terapia Intensiva, Consul.E.T.I.) study was developed in the context of a broader project launched at the Spedali Civili University Hospital of Brescia (Italy), regarding the introduction of the practice of clinical ethics consultation in Filippini et al J Anesth Analg Crit Care (2022) 2:40 complex hospital settings [15,16], beginning with the intensive care unit (ICU) [17].…”

Section: Introductionmentioning

confidence: 99%

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The need for clinical ethics consultation: a monocentric observational survey study in the intensive care unit (Consul.E.T.I. study)

Filippini

Nicoli

Picozzi

et al. 2022

J Anesth Analg Crit Care

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Background The current organizational structure of the Italian healthcare system does not include the institutionalization of clinical ethics services. To describe the need for structured clinical ethics consultation services for ICU staff members in the intensive care unit (ICU), a monocentric observational survey study was performed utilizing a paper-based questionnaire. Results A total of 73 healthcare professionals (HCPs) responded out of a team of 84 people (87%). The results showed that the need for ethics consultation in the ICU is urgent, the institutionalization of the clinical ethics service is perceived as useful and should be a priority, and the issues on which the HCPs would like ethics consultation to focus are various and belong to “end of life” topics. Conclusions HCPs believe that the clinical ethicist should become an integral part of ICU healthcare teams, offering consultations similar to the other specialistic consultations carried out in hospitals.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The need for clinical ethics consultation: a monocentric observational survey study in the intensive care unit (Consul.E.T.I. study)

Filippini

Nicoli

Picozzi

et al. 2022

J Anesth Analg Crit Care

Self Cite

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“…(1) meeting stakeholders with respect = 4.96 (2) overall positive experience = 4.82 (3) felt listened to = 4.81 (4) received sufficient information = 4.68 (5) would recommend CEC = 4.85 (6) was allowed to make important contributions = 4.77 (7) learning about ethical dilemmas = 4.44 (8) increased knowledge in navigating ethical conflict = 4.33 (9) overall new information = 3.98 (10) changes in opinion = 2.46 Proportion who disagree somewhat/strongly: (1) meeting stakeholders with respect = 0/53 (2) overall positive experience = 1/51 (3) felt listened to = 0/53 (4) received sufficient information = 1/53 (5) would recommend CEC = 2/53 (6) was allowed to make important contributions = 1/53 (7) learning about ethical dilemmas = 3/52 (8) increased knowledge in navigating ethical conflict = 1/52 (9) overall new information = 6/52 (10) Author contributions JAHB was the principal investigator and oversaw all research activities. EN was the librarian and MS and ET were graduate research assistants who assisted with data synthesis and analysis activities.…”

Section: Fundingmentioning

confidence: 99%

“…Other models suggest that the ethicist should have ethics expertise and decision-making authority or a consultative role. CEC frequently occur in acute care hospitals [ 5 ], with some programs focused on providing services in specific contexts such as intensive care units [ 6 ], pediatric areas, or end-of-life circumstances [ 7 ]. Since 2000, the rate of CEC has increased by 94% across U.S. hospitals with the median number of consults doubling in some areas.…”

Section: Introductionmentioning

confidence: 99%

Clinical ethics consultations: a scoping review of reported outcomes

et al. 2022

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Background Clinical ethics consultations (CEC) can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council (MRC) proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. Objective The primary objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization. Methods We searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. Results Forty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality (n = 31), process factors (n = 23), and clinical factors (n = 19). The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes. Conclusions This scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC.

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The Physician-Assisted Suicide Pathway in Italy: Ethical Assessment and Safeguard Approaches

Riva

2023

Bioethical Inquiry

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Although in Italy there is currently no effective law on physician-assisted suicide or euthanasia, Decision No. 242 issued by the Italian Constitutional Court on September 25, 2019 established that an individual who, under specific circumstances, has facilitated the implementation of an independent and freely-formed resolve to commit suicide by another individual is exempt from criminal liability. Following this ruling, some citizens have submitted requests for assisted suicide to the public health system, generating a situation of great uncertainty in the application processes. As a matter of fact, shared and defined procedures are lacking as Decision 242/2019 merely added some principles on which the legislature will have to base its future intervention. This paper analyses the advisory role that the Decision attributes to territorial ethics committees with the aim of stimulating discussions on their role in oversight mechanisms. The proposed conclusion is that the envisaged role does not appear consistent with the functions of these bodies and is ultimately substantially undefined and unjustified.

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Clinical ethics consultation in the intensive care unit

Cited by 11 publications

References 49 publications

The need for clinical ethics consultation: a monocentric observational survey study in the intensive care unit (Consul.E.T.I. study)

The need for clinical ethics consultation: a monocentric observational survey study in the intensive care unit (Consul.E.T.I. study)

Clinical ethics consultations: a scoping review of reported outcomes

The Physician-Assisted Suicide Pathway in Italy: Ethical Assessment and Safeguard Approaches

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