Ethical Considerations

Biddison, Lee Daugherty; Berkowitz, Kenneth A.; Courtney, Brooke; Jong, Col Marla J. De; Devereaux, Asha V.; Kissoon, Niranjan; Roxland, Beth E.; Sprung, Charles L.; Dichter, Jeffrey R.; Christian, Michael D.; Powell, Tia

doi:10.1378/chest.14-0742

Cited by 148 publications

(42 citation statements)

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“…1 Collaboration can facilitate and promote plan acceptance; development of consistent triggers for activation and deactivation; and identification of clear and predictable lines of authority and decision-making, existing legal protections and gaps, and fair approaches for plan improvement and revision. 1 Also integral to the planning process is identifying ethical principles to guide MCC decision-making (see the “Ethical Considerations” article by Daugherty Biddison et al 22 in this consensus statement). 23,24 To help confirm that MCC plans are just, as fair as possible, and accepted when implemented, comprehensive vetting by qualified experts and public engagement are needed (see the “Engagement and Education” article by Devereaux et al 25 in this consensus statement).…”

Section: Resultsmentioning

confidence: 99%

“…They also are accountable for the triage decisions they make and processes in which they are involved. 23,36 Impromptu and independent departures by clinicians from formally adopted and vetted plans may have legal, ethical, and public health ramifications (see the “Ethical Considerations” article by Daugherty Biddison et al 22 in this consensus statement). 11 During MCC (and ideally before such emergencies through public engagement), 1 it is critical that these practitioners effectively and transparently manage patient and family expectations upon arrival at the hospital.…”

Section: Resultsmentioning

confidence: 99%

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Legal Preparedness

Courtney¹,

Hodge

Toner

et al. 2014

Chest

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BACKGROUND Significant legal challenges arise when health-care resources become scarce and population-based approaches to care are implemented during severe disasters and pandemics. Recent emergencies highlight the serious legal, economic, and health impacts that can be associated with responding in austere conditions and the critical importance of comprehensive, collaborative health response system planning. This article discusses legal suggestions developed by the American College of Chest Physicians (CHEST) Task Force for Mass Critical Care to support planning and response efforts for mass casualty incidents involving critically ill or injured patients. The suggestions in this chapter are important for all of those involved in a pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS Following the CHEST Guidelines Oversight Committee’s methodology, the Legal Panel developed 35 key questions for which specific literature searches were then conducted. The literature in this field is not suitable to provide support for evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process resulting in seven final suggestions. RESULTS Acceptance is widespread for the health-care community’s duty to appropriately plan for and respond to severe disasters and pandemics. Hospitals, public health entities, and clinicians have an obligation to develop comprehensive, vetted plans for mass casualty incidents involving critically ill or injured patients. Such plans should address processes for evacuation and limited appeals and reviews of care decisions. To legitimize responses, deter independent actions, and trigger liability protections, mass critical care (MCC) plans should be formally activated when facilities and practitioners shift to providing MCC. Adherence to official MCC plans should contribute to protecting hospitals and practitioners who act in good faith from liability. Finally, to address anticipated staffing shortages during severe and prolonged disasters and pandemics, governments should develop approaches to formally expand the availability of qualified health-care workers, such as through using official foreign medical teams. CONCLUSIONS As a fundamental element of health-care and public health emergency planning and preparedness, the law underlies critical aspects of disaster and pandemic responses. Effective responses require comprehensive advance planning efforts that include assessments of complex legal issues and authorities. Recent disasters have shown that although law is a critical response tool, it can also be used to hold health-care stakeholders who fail to appropriately plan for or respond to disasters and pandemics accountable for resulting patient or staff harm. Claims of liability from harms allegedly suffered during disasters and pandemics cannot be avoided altogether. However, appropriate planning and l...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Legal Preparedness

Courtney¹,

Hodge

Toner

et al. 2014

Chest

Self Cite

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“…The questionnaire is a modification of Fry and Duffy Ethical issues scale [9]. which was used for psychometric analysis of ethical issues in 2002.…”

Section: Research Instrumentsmentioning

confidence: 99%

Sociodemographic Factors Influencing the Experience of Ethical Dilemmas Among Nurses in Critical Care Unit of Kenyatta National Hospital

Mutinda¹

2017

AJNS

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Abstract:Ethical issues have emerged in the recent years as a major component of health care for the critically ill patients, who are vulnerable and totally depend on nurse working in the critical care unit. The perception and magnitude of ethical dilemmas faced by nurses working in critical care unit of Kenyatta National Hospital (KNH) as well as the sociodemographic factors influencing this experience had not been determined. This exploratory survey was conducted on 123 nurses working in three critical care areas of the Kenyatta National Hospital. The research aimed to identify the ethical dilemmas by nurses working in Critical Care Units of the Kenyatta National Hospital in their everyday practice and the socio-demographic factors influencing the experience. Personnel records showed the nurses had varying socio-demographic characteristics which were found to influence the experience of dilemmas. Data were collected using questionnaires which were distributed to the123 nurses working in the critical care areas. The participants were selected using stratified random sampling method. Data was cleaned and analyzed using SPSS. Chi square test was used to assess the relationship between variables. The following were identified as the emerging ethical issues: end-of-life decisions (prolonging the dying process, withholding treatment, DNR orders and patients' religious values), Patient care issues (unsafe nurse-patient ratios, allocation of scarce medical resources, breaches of patients' privacy, ignoring patients' autonomy, dealing with incompetent colleagues, discriminatory treatment of patients, patient/ relatives uninformed about the patient's prognosis) and human rights issues (advance directives, informed consent, rights of pediatric patients and nursing of critically ill patients posing a risk to nurses). Various factors have been attributed to influencing the way one perceives ethical dilemmas. These include knowledge, age and gender among others. The study focused on the socio-demographic factors that significantly affected the experience of ethical dilemmas which included: age, professional qualification and level of knowledge of ethical issues. In conclusion this study shows that ethical dilemmas are an issue of concern among the nurses working in the critical care units of the KNH. The experience of ethical dilemmas is influenced by various socio-demographic factors.Keywords: Ethical Dilemmas, Critical Care Areas, Critical Care Nursing, Socio-demographic Factors BackgroundNurses are the largest group of healthcare providers serving in all the facilities providing health services. In Kenya they form 80% of the workforce as depicted in the Kenya national workforce and training analysis data (16). Nurses are deployed in nearly all the departments in the health care institutions to include the critical care units where they face various issues and are required to make decisions pertaining to patient care.Contemporary studies done in developed countries have consistently demonstrated that nurses working in cri...

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“…Triage and allocation of limited resources in public health emergencies are still one of the most challenging issues in disaster medicine [13] because health care providers are not expected to make decisions to restrict the care of the patients or their rights [14]. Relying on ethical criteria for decision-making separates triage from arbitrary biased decisions based on personal judgment [12].…”

mentioning

confidence: 99%

Ethical Patient Prioritization in Disaster Triage: A Protocol for a Systematic Review

Ghanbari

Zareiyan

Nejati

et al. 2019

HDQ

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Background: Disasters are medically defined as events in which the demands for patients' care far exceed the available resources. In such situations, triage and rationing of limited resources are inevitable. A decision regarding triage needs not only scientific guidelines but also an ethical framework and supporting policies. This study aims to provide a comprehensive review of the criteria for ethical decision-making in disasters triage. Materials and Methods: Medline (Via pubMed.com), Scopus, Web of Science, and ProQuest databases will be searched from 1990 to July 2017 using a defined search strategy. Other search resources include Google Scholar, World Health Library, Global Ethics Library, Gray Literature Report website, and World Health Organization (WHO), which will be searched using a modified search strategy. The manual search will be conducted in two journals with the highest number of retrieved titles in the Scopus search and the reference list of selected articles. Study selection, quality assessment, and data extraction will be done by the first author, and the second reviewer will check the results, and probable disagreements will be resolved through discussion and review by a third reviewer. Results: This systematic review will identify all factors a triage officer should be considered when he or she would like to make an ethical decision. Conclusion: Transparency and consistency are two main procedural ethical values of disaster triage. The result of this review could be used to make a consistent decision in disaster triage.

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Ethical Considerations

Cited by 148 publications

References 50 publications

Legal Preparedness

Legal Preparedness

Sociodemographic Factors Influencing the Experience of Ethical Dilemmas Among Nurses in Critical Care Unit of Kenyatta National Hospital

Ethical Patient Prioritization in Disaster Triage: A Protocol for a Systematic Review

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