Ethical Issues and Palliative Care in the Cardiovascular Intensive Care Unit

Cumulative Incidence of Death and Rehospitalization Among the Elderly in the First Year after NSTEMI

“…Given the acceleration of pharmacologic and technological advances in treatment of acute ischemic heart disease, it has become critically important to better understand symptom burden, goals of care, and reassessment of care options in older adults suffering acute myocardial infarction. 33 Multidisciplinary teams that include providers experienced in transitional and palliative care may offer unique perspectives to align the patient's health care goals with the care plan.…”

Palliative Care in the Cardiac Intensive Care Unit

“…4 Challenges associated with, and ways in which to improve on, the integration and delivery of palliative care services specifically pertaining to the CICU setting were recently addressed by Swetz and Mansel. 10 Ultimately, we envision a combined integrative and consultative approach to palliative care in the CICU in which the primary team addresses aspects of care pertaining to palliative care on a daily basis. The team would seek the assistance of a more formalized palliative care consultation when additional expertise is requested to help with symptom management, conflict resolution, and aligning GOC between the primary team and the patient and family.…”

Ethical Dilemmas in the Intensive Care Unit

“…The nature of bioethics is to approach individual patient cases by looking not just at what can be done, but rather what should be done. 1 Ethics consultants are often brought on board in cases where there is moral dilemma or conflicting values about patient autonomy, surrogate decision making, goals of care, and transitions to EOL care. 8 Palliative care teams may be called upon for similar reasons, and their presence is growing rapidly as health care professionals and patients are benefiting from the added layer of physical, spiritual, and psychosocial support provided at various points along the disease trajectory.…”

“…This represents more than 500 000 patients each year who die in or after an ICU stay either with a ''do not resuscitate'' order in place or with full resuscitation efforts by medical and nursing staff. 1 Death and dying is not a new phenomenon occurring in ICUs; the very nature of this level of care is that patients are at their sickest and most acute phases of illness. The difference lies with advances in medical technology and pharmacologic therapies that have the potential to extend life but also fuel the fire of an already death-denying culture.…”

“…Patients and families are now being faced with numerous decisions at a time when outcomes are uncertain and stakes are high. 1 As critical care teams are confronted with the increasing demands of this patient population, ethics and palliative care consultants are being called upon to assist with a host of frequently encountered ethical dilemmas. It is also because of this increased demand that ICUs have become a focus of interest for many hospital-based palliative care teams.…”