In a previously published multicenter, prospective, randomized,
controlled trial of more than 500 intensive care unit patients involved in
conflicts over treatment decisions, ethics consultations were found to be
helpful in resolving the conflicts and reducing nonbeneficial treatments.
The intervention received favorable reviews by 80% of patient surrogates
and more than 90% of physicians and nurses. Nevertheless, several
participants in the ethics consultation process expressed dissatisfactions
with the intervention. In this paper, we report our efforts to determine
the factors associated with these negative responses in hopes that we
might provide insights of future use to ethics consultants.We gratefully acknowledge the contributions of
Jeffrey Blustein, Kathleen B. Briggs, Ronald Cranford, Glen I. Komatsu,
and Ernle W.D. Young to the original randomized controlled trial phase of
this research. Grant support came from the Agency for Healthcare Research
and Quality, 1 R01 HS10251.