Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-06T13:56:55.462Z Has data issue: false hasContentIssue false

Multi-Professional Recommendations for Access and Utilization of Critical Care Services: Towards Consistency in Practice and Ethical Decision-Making Processes

Published online by Cambridge University Press:  01 January 2021

Extract

The ethics sections of Critical Care Societies have issued position statements and proposed a variety of position papers and policies describing the appropriate use of critical care services. These policies describe the goals of critical care provision — to support a patient through an acute, potentially reversible, life-threatening illness — and provide broad guidance on physiological and hemodynamic criteria that require the specialized care of an ICU environment. In recent years, many critical care professionals have, however, reported providing care they felt was inappropriate or futile even though most felt they should not have done so. Futile care encompasses treatments that will not work or treatments that have no chance of providing any benefit. ICU teams define care as inappropriate when it fails to restore a person to an awareness of self, and an ability to interact with their environment particularly when a lot of critical care resources are required. When patients experience significant amounts of pain and suffering, such care seems even more inappropriate.

Type
Independent
Copyright
Copyright © American Society of Law, Medicine and Ethics 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Society of Critical Care Medicine, Guidelines for ICU Admission, Discharge and Triage, 1999, available at <www.sccm.org/professional_resources/guidelines/table_of_contents/Documents/ICU_ADT.pdf> (last visited March 10, 2010); Thompson, B. T., Cox, P. N., Antonelli, M., Carlet, J. M., Cassell, J., Hill, N. S., Hinds, C. J., Pimentel, J. M., Reinhart, K., and Thijs, L. G., “Challenges in End-of-Life Care in the ICU: Statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003: Executive Summary,” Critical Care Medicine 32, no. 8 (2004) 17811784.CrossRefGoogle Scholar
Id. (Thompson, et al.); id. (Society of Critical Care Medicine).Google Scholar
Palda, V. A., Bowman, K. W., McLean, R. F., Chapman, M. G., “‘Futile’” Care: Do We Provide It? Why? A Semistructured, Canada-Wide Survey of Intensive Care Unit Doctors and Nurses,” Journal of Critical Care 20, no. 4 (2005): 207213; Vincent, J. L., Forgoing Life Support in Western European Intensive Care Units: The Results of an Ethical Questionnaire,” Critical Care Medicine 27, no. 8 (1999): 1626–1633.CrossRefGoogle Scholar
Sibbald, R., Downar, J., and Hawryluck, L., “Perceptions of ‘Futile Care’ among Caregivers in Intensive Care Units,” Canadian Medical Association Journal 177, no. 10 (2007): 12011208.CrossRefGoogle Scholar
Id. Gibson, J., Ethical Approaches to Resource Allocation in Critical Care: A Literature Review Prepared for the Critical Care Strategy, Ministry of Health and Long Term Care, 2006; Daniels, N. and Sabin, J., Setting Limits Fairly: Can We learn to Share Medical Resources? (New York: Oxford University Press, 2002); Gibson, J. L., Martin, D. K., and Singer, P. A., “Priority Setting in Hospitals: Fairness, Inclusiveness, and the Problem of Institutional Power Differences,” Social Science Medicine 61 no. 11 (December 2005): 2355–2362; Kucis, L., Implications for Policy Development: A Report Created for the Critical Care Strategy - Ministry of Health and Long Term Care, 2007; Hawryluck, L. and Hodder, R., eds., End-of-Life Communication in the ICU, CRI Critical Care Education Network, Ottawa, ON, 2008.Google Scholar
Id. (Gibson, ); id. (Daniels, and Sabin, ); id. (Gibson, et al.).Google Scholar
Health Care Consent Act, 1996, S.O. 1996, c. 2, Sch. A.Google Scholar
Pope, T. M., “Medical Futility Statutes: No Safe Harbor to Unilaterally Refuse Life-Sustaining Treatments,” Tennessee Law Review 75, no. 1 (2007): 181.Google Scholar
Straus, S. and Stelfox, T., “Whose Life Is It Anyway? Capacity and Consent in Canada,” Canadian Medical Association Journal 177, no. 1 (2007): 1329; Fan, E. and Needham, D. M., “Deciding Who to Admit to a Critical Care Unit,” BMJ 335, no. 7630 (2007): 1103–1104.CrossRefGoogle Scholar
See Pope, , supra note 9.Google Scholar
See supra note 10.Google Scholar
See supra note 7.Google Scholar
Ferrand, E., Lemaire, F., Regnier, B., Kuteifan, K., Badet, M., Asfar, P., Jaber, S., Chagnon, J. L., Renault, A., and Robert, R. et al., “Discrepancies between Perceptions by Physicians and Nursing staff of Intensive Care Unit End-of-Life Decisions,” American Journal of Respirology and Critical Care Medicine 167 (2003): 13101315.CrossRefGoogle Scholar
Baggs, J. G., Schmitt, M. H., Mushlin, A. I., Mitchell, P. H., Eldredge, D. H., Oakes, D., and Hutson, A. D., “Association between Nurse-Physician Collaboration and Patient Outcomes in Three Intensive Care Units,” Critical Care Medicine 27, no. 9 (1999): 1991–1998; Gilligan, T. and Raffin, T. A., “Whose Death Is It Anyway?” Annals of Internal Medicine 125, no. 2 (1996): 137–140.CrossRefGoogle Scholar
Danjoux, N., Lawless, B., and Hawryluck, H., “Conflicts in the ICU: Perspectives of Administrators and Clinicians,” Intensive Care Medicine 35, no. 12 (December 2009): 20682077.CrossRefGoogle Scholar
See Health Care Consent Act, supra note 8.Google Scholar
Studdert, D. M., Mello, M. M., Burns, J. P., Puopolo, A. L., Galper, B. Z., Truog, R. D., and Brennan, T. A., “Conflict in the Care of Patients with Prolonged Stay in the ICU: Types, Sources, and Predictors,” Intensive Care Medicine 29, no. 9 (2003): 14891497; Burns, J. P., Mello, M. M., Studdert, D. M. et al., “Results of a Clinical Trial on Care Improvement for the Critically Ill,” Critical Care Medicine 31, no. 8 (2003): 2107–2117; Fisher, M., “Ethical Issues in the Intensive Care Unit,” Current Opinion in Critical Care 10, no. 4 (2004): 292–298; Oberle, K. and Hughes, D., “Doctors’ and Nurses’ Perceptions of Ethical Problems in End-of-Life Decisions,” Journal of Advanced Nursing 33, no. 6 (2001): 707–715; Fetters, M. D., Churchill, L., and Danis, M., “Conflict Resolution at the End of Life,” Critical Care Medicine 29, no. 5 (2001): 921–925; Breen, C. M., Abernethy, A. P., Abbott, K. H., and Tulsky, J. A., “Conflict Associated with Decisions to Limit Life-Sustaining Treatment in Intensive Care Units,” Journal of General Internal Medicine 16, no. 5 (2001): 283–289.CrossRefGoogle Scholar
See Fan, and Needham, , supra note 10; Meisel, A., “Quality of Life and End of Life Decision-Making,” Quality of Life Research 12, Supp. 1 (2003): 9194.Google Scholar
See Baggs, et al., supra note 15.Google Scholar