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58 - Critical and intensive care ethics

Published online by Cambridge University Press:  30 October 2009

By
Philip D. Levine  and
Charles L. Sprung
Edited by
Peter A. Singer  and
A. M. Viens
Philip D. Levine
Affiliation:
Attending Physician Department of Anesthesiology and Critical Care Medicine Hadassah Hebrew University Hospital Jerusalem, Israel
Charles L. Sprung
Affiliation:
Professor of Medicine and Critical Care Medicine Hadassah University Hospital Jerusalem, Israel
Peter A. Singer
Affiliation:
University of Toronto
A. M. Viens
Affiliation:
University of Oxford
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Summary

A 70-year-old male patient (Patient E) is admitted to the intensive care unit (ICU) following a road traffic accident in which he suffered severe head and abdominal injuries. After four weeks in the ICU, the patient's neurological condition has stabilized with minimal function (the patient does not communicate but withdraws all four limbs to painful stimuli). Following numerous bouts of sepsis, the patient is developing renal failure. He is anuric, hyperkalemic, and acidotic. He is also ventilator dependent and on high doses of inotropes. The patient's family states that in their culture, life continues until the heart stops beating. The family (that includes a physician) requests that all resuscitative efforts be continued, including dialysis.

In parallel, a second patient (Patient F) with similar injuries, but with metastatic prostate cancer, is admitted to the emergency room and requires an ICU bed. In addition to his traumatic injuries, however, he is wheel-chair bound as a result of dementia. No beds are currently available. According to the assessment of the ICU physician attending, the trauma patient described in case one has the least to benefit from ICU therapy and should be assessed for withdrawal of ventilation, to which the family strenuously objects.

What is critical and intensive care ethics?

Many aspects of medical care practiced today would not be feasible without the support of an intensive care unit (ICU).

Type
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Information
The Cambridge Textbook of Bioethics , pp. 462 - 468
Publisher: Cambridge University Press
Print publication year: 2008

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References

Alemayehu, E., Molloy, D. W., Guyatt, G. H., et al. (1991). “Variability in physicians” decisions on caring for chronically ill elderly patients: an international study. CMAJ 144: 1133–8.Google Scholar
American Medical Association (2006). Code of Medical Ethics. Chicago, IL: American Medical Association.Google Scholar
American Thoracic Society (1991). Withholding and withdrawing life-sustaining therapy. This Official Statement of the American Thoracic Society was adopted by the ATS Board of Directors, March 1991. Am Rev Respir Dis 144: 726–31.Google Scholar
American Thoracic Society (1997). Fair allocation of intensive care unit resources. Am J Respir Crit Care Med 156: 1282–1301.CrossRefGoogle Scholar
Asch, D. A., Hansen-Flaschen, J., and Lanken, P. N. (1995). Decisions to limit or continue life-sustaining treatment by critical care physicians in the United States: conflicts between physicians' practices and patients' wishesAm J Respir Crit Care Med 151: 288–92.CrossRefGoogle ScholarPubMed
Blackhall, L. J., Frank, G., Murphy, S. T., et al. (1999). Ethnicity and attitudes towards life sustaining technology. Soc Sci Med 48: 1779–89.CrossRefGoogle ScholarPubMed
Chelluri, L., Pinsky, M. R., Donahoe, M. P., and Grenvik, A. (1993). Long-term outcome of critically ill elderly patients requiring intensive care. JAMA 269: 3119–23.CrossRefGoogle ScholarPubMed
Cohen, S., Sprung, C., Sjokvist, P., et al. (2005). Communication of end of life decisions in European intensive care units. Intensive Care Med 31: 1215–21.CrossRefGoogle ScholarPubMed
Cook, D. J., Guyatt, G. H., Jaeschke, R., et al. (1995). Determinants in Canadian health care workers of the decision to withdraw life support from the critically ill. Canadian Critical Care Trials Group. JAMA 273: 703–8.CrossRefGoogle ScholarPubMed
Daly, K., Beale, R., and Chang, R. W. (2001). Reduction in mortality after inappropriate early discharge from intensive care unit: logistic regression triage model. BMJ 322: 1274–6.CrossRefGoogle ScholarPubMed
Danis, M., Patrick, D. L., Southerland, L. I., and Green, M. L. (1988). Patients' and families' preferences for medical intensive care. JAMA 260: 797–802.CrossRefGoogle ScholarPubMed
Demoule, A., Cracco, C., Lefort, Y., et al. (2005). Patients aged 90 years or older in the intensive care unit. J Gerontol A Biol Sci Med Sci 60: 129–32.CrossRefGoogle ScholarPubMed
Eidelman, L. A., Jakobson, D. J., Pizov, R., et al. (1998). Foregoing life-sustaining treatment in an Israeli ICU. Intensive Care Med 24: 162–6.CrossRefGoogle Scholar
Fletcher, J. C. and Siegler, M. (1996). What are the goals of ethics consultation? A consensus statement. J Clin Ethics 7: 122–6.Google ScholarPubMed
Garrouste-Org, M., Montuclard, L., Timsit, J. F., et al. (2005). Predictors of intensive care unit refusal in French intensive care units: a multiple-center study. Crit Care Med 33: 750–5.CrossRefGoogle Scholar
Gostin, L. O. (1997). Deciding life and death in the courtroom. From Quinlan to Cruzan, Glucksberg, and Vacco: a brief history and analysis of constitutional protection of the “right to die.”JAMA 278: 1523–8.CrossRefGoogle Scholar
Ip, M., Gilligan, T., Koenig, B., and Raffin, T. A. (1998). Ethical decision-making in critical care in Hong Kong. Crit Care Med 26: 447–51.CrossRefGoogle ScholarPubMed
Jacobs, P. and Noseworthy, T. W. (1990). National estimates of intensive care utilization and costs: Canada and the United States. Crit Care Med 18: 1282–6.CrossRefGoogle ScholarPubMed
Marbella, A. M., Desbiens, N. A., Mueller-Rizner, N., and Layde, P. M. (1998). Surrogates' agreement with patients' resuscitation preferences: effect of age, relationship, and SUPPORT intervention. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Crit Care 13: 140–5.CrossRefGoogle Scholar
Mendelsohn, A. B., Belle, S. H., Fischhoff, B., et al. (2002). How patients feel about prolonged mechanical ventilation 1 year later. Crit Care Med 30: 1439–45.CrossRefGoogle ScholarPubMed
Moreno, R., Miranda, D. R., Matos, R., and Fevereiro, T. (2001). Mortality after discharge from intensive care: the impact of organ system failure and nursing workload use at discharge. Intensive Care Med 27: 999–1004.CrossRefGoogle ScholarPubMed
Nakata, Y., Goto, T., and Morita, S. (1998). Serving the emperor without asking: critical care ethics in Japan. J Med Philos 23: 601–15.CrossRefGoogle ScholarPubMed
Prendergast, T. J. and Luce, J. M. (1997). Increasing incidence of withholding and withdrawal of life support from the critically ill. Am J Respir Crit Care Med 155: 15–20.CrossRefGoogle ScholarPubMed
Prendergast, T. J., Claessens, M. T., and Luce, J. M. (1998). A national survey of end of life care for critically ill patients. Am J Respir Crit Care Med 158: 1163–7.CrossRefGoogle ScholarPubMed
Russell, S. (1999). An exploratory study of patients' perceptions, memories and experiences of an intensive care unit. J Adv Nurs 29: 783–91.CrossRefGoogle ScholarPubMed
Seckler, A. B., Meier, D. E., Mulvihill, M., and Paris, B. E. (1991). Substituted judgment: how accurate are proxy predictions?Ann Intern Med 115: 92–8.CrossRefGoogle ScholarPubMed
Sinuff, T., Kahnamoui, K., Cook, D. J., Luce, J. M., and Levy, M. M. (2004). Rationing critical care beds: a systematic review. Crit Care Med 32: 1588–97.CrossRefGoogle ScholarPubMed
Sirio, C. A., Tajimi, K., Taenaka, N., et al. (2002). A cross-cultural comparison of critical care delivery: Japan and the United States. Chest 121: 539–48.CrossRefGoogle ScholarPubMed
Smedira, N. G., Evans, B. H., Grais, L. S., et al. (1990). Withholding and withdrawal of life support from the critically ill. N Engl J Med 322: 309–15.CrossRefGoogle ScholarPubMed
Society of Critical Care Medicine Ethics Committee (1992). Attitudes of critical care medicine professionals concerning forgoing life-sustaining treatments. Crit Care Med 20: 320–6.CrossRefGoogle Scholar
Society of Critical Care Medicine Ethics Committee (1994). Attitudes of critical care medicine professionals concerning distribution of intensive care resources. Crit Care Med 22: 358–62.CrossRefGoogle Scholar
Sonnenblick, M., Friedlander, Y., and Steinberg, A. (1993). Dissociation between the wishes of terminally ill parents and decisions by their offspring. J Am Geriatr Soc 41: 599–604.CrossRefGoogle ScholarPubMed
Sprung, C. L., Cohen, S. L., Sjokvist, P., et al. (2003). End-of-life practices in European intensive care units: the Ethicus Study. JAMA 290: 790–7.CrossRefGoogle ScholarPubMed
Studdert, D. M., Mello, M. M., Burns, J. P., et al. (2003). Conflict in the care of patients with prolonged stay in the ICU: types, sources, and predictors. Intensive Care Med 29: 1489–97.CrossRefGoogle ScholarPubMed
Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine (1999). Guidelines for intensive care unit admission, discharge, and triage. Crit Care Med 27: 633–8.CrossRefGoogle Scholar
UK General Medical Counil (2006). Good Medical Pratice. London: General Medical Council.Google Scholar
Vincent, J. L. (1999). Forgoing life support in western European intensive care units: the results of an ethical questionnaire. Crit Care Med 27: 1626–33.CrossRefGoogle ScholarPubMed
Yaguchi, A., Truog, R. D., Curtis, J. R., et al. (2005). International differences in end-of-life attitudes in the intensive care unit: results of a survey. Arch Intern Med 165: 1970–75.CrossRefGoogle ScholarPubMed

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  • Critical and intensive care ethics
    • By Philip D. Levine, Attending Physician Department of Anesthesiology and Critical Care Medicine Hadassah Hebrew University Hospital Jerusalem, Israel, Charles L. Sprung, Professor of Medicine and Critical Care Medicine Hadassah University Hospital Jerusalem, Israel
  • Edited by Peter A. Singer, University of Toronto, A. M. Viens, University of Oxford
  • Book: The Cambridge Textbook of Bioethics
  • Online publication: 30 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545566.068
Available formats
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Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Critical and intensive care ethics
    • By Philip D. Levine, Attending Physician Department of Anesthesiology and Critical Care Medicine Hadassah Hebrew University Hospital Jerusalem, Israel, Charles L. Sprung, Professor of Medicine and Critical Care Medicine Hadassah University Hospital Jerusalem, Israel
  • Edited by Peter A. Singer, University of Toronto, A. M. Viens, University of Oxford
  • Book: The Cambridge Textbook of Bioethics
  • Online publication: 30 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545566.068
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Critical and intensive care ethics
    • By Philip D. Levine, Attending Physician Department of Anesthesiology and Critical Care Medicine Hadassah Hebrew University Hospital Jerusalem, Israel, Charles L. Sprung, Professor of Medicine and Critical Care Medicine Hadassah University Hospital Jerusalem, Israel
  • Edited by Peter A. Singer, University of Toronto, A. M. Viens, University of Oxford
  • Book: The Cambridge Textbook of Bioethics
  • Online publication: 30 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545566.068
Available formats
×