Ethical Issues in the Pediatric Intensive Care Unit (original) (raw)

Ethics in the Intensive Care Unit

Critical Care Clinics, 1997

Ethical considerations in the adult and pediatric intensive care unit (ICU) often involve moments of crisis marked by disagreement over decisions, such as whether to resuscitate a patient; to extubate and allow the patient to die; to hasten actively a patient's death; to withhold or withdraw unilaterally so-called futile treatment over a patient's or family's objections; or to allocate limited or expensive resources, such as extracorporeal membrane oxygenation or the last ICU bed. The expansion of technology (such as nitric oxide, high-frequency oscillatory ventilation, and partial liquid ventilation) combined with the awareness of biologic, economic, and ethical limits to applying that technology may lead to uncertainty and conflict when faced with our apparent inability to restore a patient to his or her previous state of personal well-being. Such questions are important; however, we often are left with the false impression that ethics only comes into play in these problematic situations existing at the margins of our technical skill, rather than in our everyday care of critically ill patients. As such, ethics becomes identified with an ethics committee or consultant called only when we have failed A previous version of this article was presented to the 1997 Current Concepts in Pediatric Critical Care, sponsored by the Society of Critical Care Medicine, and held in San Diego, California.

Ethics and law in the intensive care unit

Best Practice & Research Clinical Anaesthesiology, 2006

Intensive Care Medicine epitomises the difficulties inherent in modern medicine. In this chapter we examine some key medicolegal and ethical areas that are evolving. The principles of autonomy and consent are well established, but developments in UK caselaw have shown that the courts may be moving away from their traditional deference of the medical profession. We examine some recent cases and discuss the impact that these cases may have on practice in Intensive Care.

Patient's Autonomy and Medical treatment.pdf

The right to health has long been advocated as a basic human right, Jonathon Montgomery has suggested it may be thought that, like rights to life and to liberty, the right to health care could be regarded as one of a group of basic rights which make active citizenship possible; and as with all the basic rights, the State would be required to take specific steps to recognise health rights. Before a detailed programme for implementation of health rights could be drawn up, there are a series of preliminary issues to be addressed. Conceptual difficulties exist in relation to the idea of health and the causes of ill-health. The former needs consideration to establish the content of health rights and the latter in order to address the strategies appropriate to realise them. Nobody knows how much health care will be worth to him in terms of money and pain. In addition, nobody knows if the most advantageous form of health care; whether same is obtained from medical producers or the patient’s own conception of what is medically good for him or herself. For the patients seeking relief, the statement “the requirement that a patient must give a valid consent to medical treatment and its corollary, that it is the patient’s prerogative to refuse treatment, even that which will save his life, are issues of medical law” will often be interred in their thinking. Nonetheless, the art of medical treatment is not the sole prerogative of medical law. If so conceded, then it may have its justification in the expression the economics of health is a curious discipline and factors in a lot of considerations in the art of healthcare delivery. Healthcare is subject to the legal and the ethical concerns of every legal system and these concerns share the goal of creating and maintaining social good and have a symbiotic relationship with healthcare. Most often, doctors are regarded as having a positive duty to do good which expressed in the principle of beneficence which is at work when we consider the doctrine of ‘double effect’. Imagine a gravely ill patient in the last stages of terminal cancer, the patient is in pain and only a substantial dose of morphine will relieve the pain. However, such a large dose will also hasten the patient’s death, as far as medical ethics is concerned; the principle of beneficence means here that the doctor’s only intention is to do good, that is, to relieve pain. . On the contrary, a strong argument is made for patient’s autonomy to give consent and refuse treatment. The element of consent is one of the critical issues in medical treatment. The patient has a legal right to autonomy and self-determination; he can refuse treatment except in an emergency situation where the doctor need not get consent for treatment. Any treatment against this supreme god, patient autonomy will be blasphemy against same. Consequently, the treatment without proper consent is generally considered assault which is capable of being tried in the criminal law and in tort. Two major ethical theories are vying for dominance in medical ethics. Firstly, the liberty and autonomy of the individual and second, the theory of social utility rather than individual autonomy. This requires that the physician act to maximise benefits and goods even if this might demand acting without the patient’s consent. It sanctions overriding the patient’s autonomous decision if that decision is not judged by the physician to be in the patient’s or society’s good.

The right to forego life-sustaining treatment: legal trends and emerging issues

Journal of health and human resources administration, 1989

• 'From the day they enter medical school, physicians are Laught t.o cherish and preserve life. However, there comes a time with the terminally iU or irreversible comatose patient that the physician must step back and, at the patient's or the family's request, allow the patient to die with dignity." [I)

Ethical problems in intensive care unit admission and discharge decisions

HetNederlands tijdschrift voor evidence based practice, 2016

Background: There have been few empirical studies into what non-medical factors influence physicians and nurses when deciding about admission and discharge of ICU patients. Information about the attitudes of healthcare professionals about this process can be used to improve decision-making about resource allocation in intensive care. To provide insight into ethical problems that influence the ICU admission and discharge process, we aimed to identify and explore ethical dilemmas healthcare professionals are faced with. Methods: This was an explorative, descriptive study using qualitative methods (individual and focus group interviews). We conducted 19 individual interviews and 4 focus group interviews with nurses and physicians working in the ICU or the general ward of 10 Dutch hospitals. Results: The ethical problems in the context of ICU admission and discharge can be divided into problems concerning full bed occupancy and problems related to treatment decisions. The gap between the high level of care the ICU can provide and the lower care level in the general ward sometimes leads to mutual misunderstandings. Our results indicate that when professionals of different wards feel there is a collective responsibility and effort to solve a problem, this helps to prevent or alleviate moral distress. ICU patients' wishes are often unknown, causing healthcare professionals to err on the side of more treatment. Additionally, the highly technological nature of intensive care appears to encourage over-treatment. Conclusions: It is important for ICUs and general wards to communicate and cooperate well, since there is a mutual dependency for optimal patient flow between the different departments. Interventions that improve the understanding and cooperation between these wards may help mitigate ethical problems. The nature of the ICU environment makes it important for healthcare professionals to be aware of the risk of over-treatment, reflect on why they do what they do, and be mindful of a possible negative impact of over-treatment on their patients. Early discussion of a patient's wishes with regard to treatment options is important in preventing over-treatment.

MEDICAL ETHICS AND PEDIATRIC DECISION MAKING: LEGAL FRAMEWORK AND BEST INTEREST

Nancy Christian, 2024

It is a fundamental principle of medical law and ethics that a medical practitioner should obtain the informed consent of a competent patient before treating such a patient. This is in tandem with the 'principle of autonomy' and best interests of a patient. In real life, decision-making ability cannot be as simple as it sounds. When one really examines the specifics of its real world application and the issues that arise from it, its complexity becomes clear. The most complex of these complexities seems to be the possibility of ambiguity and fluidity when determining whether or not a patient has the ability. This study is a wake-up call to all sundry to recognize, promote and enforce rights of the child in every sphere. The study examines numerous legal frameworks that provide for the protection of their rights. Accordingly, in achieving this objective, the researcher adopted doctrinal method. This work therefore, considers how decisions made on behalf of those lacking capacity (in the medical context) under the Nigerian legal systems meet the needs of our contemporary societies with the aim of recommending the best practices for Nigeria as we strive to develop an efficient health care environment.