“If an acute event occurs, what should we do?” Diverse ethical approaches to decision-making in the ICU

Nicoli, Federico; Cummins, Paul; Raho, Joseph A.; Porz, Rouven; Minoja, Giulio; Picozzi, Mario

doi:10.1007/s11019-019-09887-6

Cited by 8 publications

(7 citation statements)

References 27 publications

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“…In addition, in this study, 80% of the cases were referred from the intensive care unit, which is a complex healthcare setting characterized by ethically burdensome decision-making and high levels of uncertainty and conflicts. 27 Integration of CES in the intensive care unit is often more challenging than that in general wards or outpatient clinics because of unstable patient status that requires urgent medical processes 28 despite the positive effect of ethics consultation on resource utilization and user experience. 29 Therefore, CES aimed at rapid response, such as employing the ethics consultation team or consultant, may be useful in the intensive care unit setting.…”

Section: Discussionmentioning

confidence: 99%

Ethical Issues Referred to Clinical Ethics Support at a University Hospital in Korea: Three-Year Experience After Enforcement of Life-Sustaining Treatment Decisions Act

et al. 2023

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Background Clinical ethics support is a form of preventive ethics aimed at mediating ethics-related conflicts and managing ethical issues arising in the healthcare setting. However, limited evidence exists regarding the specific ethical issues in clinical practice. This study aimed to explore the diverse ethical issues of cases referred to clinical ethics support after the new legislation on hospice palliative care and end-of-life decision-making was implemented in Korea in 2018. Methods A retrospective study of cases referred to clinical ethics support at a university hospital in Korea from February 2018 to February 2021 was conducted. The ethical issues at the time of referral were analyzed via qualitative content analysis of the ethics consultation-related documents. Results A total of 60 cases of 57 patients were included in the study, of whom 52.6% were men and 56.1% were older than 60 years of age. The majority of cases (80%) comprised patients from the intensive care unit. One-third of the patients were judged as being at the end-of-life stage. The most frequent ethical categories were identified as goals of care/treatment (78.3%), decision-making (75%), relationship (41.7%), and end-of-life issues (31.7%). More specifically, best interests (71.7%), benefits and burdens/harms (61.7%), refusal (53.3%), and surrogate decision-making (33.3%), followed by withholding or withdrawal (28.3%) were the most frequent ethical issues reported, which became diversified by year. In addition, the ethical issues appeared to differ by age group and judgment of the end-of-life stage. Conclusion The findings of this study expand the current understanding of the diverse ethical issues including decision-making and goals of care/treatment that have been referred to clinical ethics support since the enforcement of the new legislation in Korea. This study suggests a need for further research on the longitudinal exploration of ethical issues and implementation of clinical ethics support in multiple healthcare centers.

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Section: Discussionmentioning

confidence: 99%

Ethical Issues Referred to Clinical Ethics Support at a University Hospital in Korea: Three-Year Experience After Enforcement of Life-Sustaining Treatment Decisions Act

et al. 2023

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“…Moreover, the working method must also be defined, since some principles (such as that of sharing decisions within the team and between the team and the patient/family) are widely shared, but those regarding the methods of conducting a CEC are less shared in this particular care setting [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the second aim of the study, the most widespread opinion was that the ethics consultant should not only interface with the team as a whole, but also with patients and families, a factor that could express the propensity to involve the entire universe that revolves around the patient in the treatment (and decision-making) process [ 30 , 31 ]. This is much easier to achieve in an “ICU with a partial liberalization of visiting policies”.…”

Section: Discussionmentioning

confidence: 99%

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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“…This approach is not only the application of ethical principles in a particular situation because it recognizes that each situation has an unique context which prevents comparing one situation to another. It also attempts to account for imbalances in health authorities, exploring dependencies and vulnerability and giving a 'voice' to those who are not usually heard 12 . The care-based approach follows the ethical standard "do unto others as you would have them do unto you" 8 .…”

Section: Models Of Ethical Decision-makingmentioning

confidence: 99%

Clinical Ethical Consultation in Decision Making Process

BOZHIDAROVA GEORGIEVA

2023

Arch Balk Med Union

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Consultation éthique clinique dans le processus décisionnelPrendre des décisions éthiques en matière de santé nécessite souvent une expérience et une sagesse professionnelles accumulées qui sont en interaction simultanée avec les principes éthiques connus de la profession médicale. Cet article de synthèse vise à expliquer comment les consultations d'éthique clinique influencent la prise de décision dans la pratique des soins de santé. Les consultations en éthique clinique soutiennent le processus de prise de décision éthique et le rôle du consultant en éthique clinique en tant que participant est d'appliquer une approche de facilitation largement acceptée lorsqu'il traite un cas éthique. Des recommandations pourraient être faites à la demande des parties prenantes.

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“If an acute event occurs, what should we do?” Diverse ethical approaches to decision-making in the ICU

Cited by 8 publications

References 27 publications

Ethical Issues Referred to Clinical Ethics Support at a University Hospital in Korea: Three-Year Experience After Enforcement of Life-Sustaining Treatment Decisions Act

Ethical Issues Referred to Clinical Ethics Support at a University Hospital in Korea: Three-Year Experience After Enforcement of Life-Sustaining Treatment Decisions Act

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

Clinical Ethical Consultation in Decision Making Process

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