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Patients and Teams Caring for Them: Parallels Between Critical Care and Emergency Medicine

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Compelling Ethical Challenges in Critical Care and Emergency Medicine

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Abstract

In the current era of a rapidly progressing emergency/resuscitation and intensive care science, medical ethics has evolved from paternalistic to being patient-/family-centered. Ethical challenges ensuing in the emergency department (ED) and the intensive care unit (ICU) are similar and pertain to autonomy, beneficence/nonmaleficence, dignity, and justice. Major challenges are associated with the immediate necessity to intervene to save a life, patients’ decisional incapacity, timely access to advance directives, capability of surrogate decision-makers to decide according to patients’ values, preferences, and best interest, informed consent validity, potentially disproportional treatments relative to patients’ wishes and/or prognosis, prevention of patient distress after withholding or withdrawing life-sustaining measures, equality of access to best-quality care independently of factors such as race, comorbidity, and socioeconomic status, and respect for research subjects’ autonomy and dignity, as well as the actual risk-to-benefit ratio of emergency research. ED challenges are frequently associated with acute illness-imposed time constraints. Current evidence supports interventions such as advance care planning (ACP), shared decision making, and family presence during resuscitation and treatment in the ICU. Future directions and actions should be comprised of international consensus on the most efficient and appropriate application of the principles of bioethics, governmental/healthcare system policies supporting ACP, family-centered care, and shared decision-making, education, and research aimed at optimizing the quality of ethical practice.

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References

  1. Greenle MM, Hirschman KB, Coburn K, et al. End-of-life health-care utilization patterns among chronically ill older adults. Am J Hosp Palliat Care. 2019;36:507–12.

    Article  Google Scholar 

  2. Mentzelopoulos SD, Slowther AM, Fritz Z, et al. Ethical challenges in resuscitation. Intensive Care Med. 2018;44:703–16.

    Article  Google Scholar 

  3. Mentzelopoulos SD, Haywood K, Cariou A, et al. Evolution of medical ethics in resuscitation and end of life. Trends Anaesth Crit Care. 2016;10:7–14.

    Article  Google Scholar 

  4. Kon AA, Davidson JE, Morrison W, et al. American Thoracic Society. Shared decision making in ICUs: an American College of Critical Care Medicine and American Thoracic Society policy statement. Crit Care Med. 2016;44:188–201.

    Article  Google Scholar 

  5. Davidson JE, Aslakson RA, Long AC, et al. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med. 2017;45:103–28.

    Article  Google Scholar 

  6. Colaco KA, Courtright A, Andreychuk S, et al. Ethics consultation in paediatric and adult emergency departments: an assessment of clinical, ethical, learning and resource needs. J Med Ethics. 2018;44:13–20.

    Article  Google Scholar 

  7. Nates JL, Nunnally M, Kleinpell R, et al. ICU admission, discharge, and triage guidelines: a framework to enhance clinical operations, development of institutional policies, and further research. Crit Care Med. 2016;44:1553–602.

    Article  Google Scholar 

  8. Sprung CL, Geber D, Eidelman LA, et al. Evaluation of triage decisions for intensive care admission. Crit Care Med. 1999;27:1073–9.

    Article  CAS  Google Scholar 

  9. Gopalan PD, Pershad S. Decision-making in ICU—a systematic review of factors considered important by ICU clinician decision makers with regard to ICU triage decisions. J Crit Care. 2019;50:99–110.

    Article  Google Scholar 

  10. Vogel L. Can rationing possibly be rational? CMAJ. 2011;183:1242–3.

    Article  Google Scholar 

  11. Muskens IS, Gupta S, Robertson FC, et al. When time is critical, is informed consent less so? A discussion of patient autonomy in emergency neurosurgery. World Neurosurg. 2019;125:e336–e40.

    Article  Google Scholar 

  12. Roberts I, Prieto-Merino D, Shakur H, et al. Effect of consent rituals on mortality in emergency care research. Lancet. 2011;377:1071–2.

    Article  Google Scholar 

  13. Council of Europe. Guide on the decision-making process regarding medical treatment in end-of-life situations. http://www.bioethics.net/2014/05/council-of-europe-launches-guide-on-decision-making-process-regarding-medical-treatment-in-end-ofllife-situations/. Accessed 21 Mar 2019.

  14. Padela AI, Davis J, Hall S, et al. Are emergency medicine residents prepared to meet the ethical challenges of clinical practice? Findings from an exploratory national survey. AEM Educ Train. 2018;2:301–9.

    Article  Google Scholar 

  15. Kompanje EJ, Maas AI, Menon DK, et al. Medical research in emergency research in the European Union member states: tensions between theory and practice. Intensive Care Med. 2014;40:496–503.

    Article  Google Scholar 

  16. Geiderman JM, Malik S, McCarthy JJ, et al. The care of VIPs in the emergency department: triage, treatment and ethics. Am J Emerg Med. 2018;36:1881–5.

    Article  Google Scholar 

  17. Pourmand A, LeSaux M, Pines JM, et al. Caring for VIPs in the emergency department: are they VIPs or patients? Am J Emerg Med. 2018;36:895.

    Article  Google Scholar 

  18. Merin O, Miskin IN, Lin G, et al. Triage in mass-casualty events: the Haitian experience. Prehosp Disaster Med. 2011;26:386–90.

    Article  Google Scholar 

  19. Silverman HJ, Druml C, Lemaire F, et al. European Union Directive. The European Union Directive and the protection of incapacitated subjects in research: an ethical analysis. Intensive Care Med. 2004;30:1723–9.

    Article  Google Scholar 

  20. Azoulay E, Pochard F, Kentish-Barnes N, et al. FAMIREA Study Group. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med. 2005;171:987–94.

    Article  Google Scholar 

  21. Bossaert LL, Perkins GD, Askitopoulou H, et al. Ethics of resuscitation and end-of-life decisions section collaborators. European resuscitation council guidelines for resuscitation 2015: section 11. The ethics of resuscitation and end-of-life decisions. Resuscitation. 2015;95:302–11.

    Article  Google Scholar 

  22. Mentzelopoulos SD, Mantzanas M, van Belle G, et al. Evolution of European Union legislation on emergency research. Resuscitation. 2015;91:84–91.

    Article  Google Scholar 

  23. Parsa-Parsi RW. The revised declaration of Geneva: a modern-day physician’s pledge. JAMA. 2017;318:1971–2.

    Article  Google Scholar 

  24. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191–4.

    Article  Google Scholar 

  25. Andorno R, Biller-Andorno N, Brauer S. Advance health care directives: towards a coordinated European policy? Eur J Health Law. 2009;16:207–27.

    Article  Google Scholar 

  26. Berger JT, De Renzo EG, Schwartz J. Surrogate decision making: reconciling ethical theory with clinical practice. Ann Intern Med. 2008;149:48–53.

    Article  Google Scholar 

  27. Majesko A, Hong SY, Weissfeld L, et al. Identifying family members who may struggle in the role of surrogate decision maker. Crit Care Med. 2012;40:2281–6.

    Article  Google Scholar 

  28. Azoulay E, Timsit JF, Sprung CL, et al. Conflicus Study Investigators and for the Ethics Section of the European Society of Intensive Care Medicine. Prevalence and factors of intensive care unit conflicts: the conflicus study. Am J Respir Crit Care Med. 2009;180:853–60.

    Article  Google Scholar 

  29. Mentzelopoulos SD, Bossaert L, Raffay V, et al. A survey of key opinion leaders on ethical resuscitation practices in 31 European Countries. Resuscitation. 2016;100:11–7.

    Article  Google Scholar 

  30. Jabre P, Belpomme V, Azoulay E, et al. Family presence during cardiopulmonary resuscitation. N Engl J Med. 2013;368:1008–18.

    Article  CAS  Google Scholar 

  31. Ramage E, Porter JE, Biedermann N. Family presence during resuscitation (FPDR): a qualitative study of implementation experiences and opinions of emergency personnel. Australas Emerg Care. 2018;21:51–5.

    Article  Google Scholar 

  32. Wang CH, Chang WT, Huang CH, et al. Factors associated with the decision to terminate resuscitation early for adult in-hospital cardiac arrest: influence of family in an East Asian society. PLoS One. 2019;14:e0213168.

    Article  CAS  Google Scholar 

  33. Pérez Mdel V, Macchi MJ, Agranatti AF. Advance directives in the context of end-of-life palliative care. Curr Opin Support Palliat Care. 2013;7:406–10.

    Article  Google Scholar 

  34. Silveira MJ, Kim SY, Langa KM. Advance directives and outcomes of surrogate decision making before death. N Engl J Med. 2010;362:1211–8.

    Article  CAS  Google Scholar 

  35. Jesus JE, Marshall KD, Kraus CK, et al. American College of Emergency Physicians (ACEP) Ethics Committee. Should emergency department patients with end-of-life directives be admitted to the ICU? J Emerg Med. 2018;55:435–40.

    Article  Google Scholar 

  36. Moss AH, Zive DM, Falkenstine EC, et al. The quality of POLST completion to guide treatment: a 2-state study. J Am Med Dir Assoc. 2017;18:810.e5–9.

    Article  Google Scholar 

  37. Yarnell CJ, Fu L, Manuel D, Tanuseputro P, et al. Association between immigrant status and end-of-life care in Ontario, Canada. JAMA. 2017;318:1479–88.

    Article  Google Scholar 

  38. Downar J, Delaney JW, Hawryluck L, et al. Guidelines for the withdrawal of life-sustaining measures. Intensive Care Med. 2016;42:1003–17.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece

    Spyros D. Mentzelopoulos

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  1. Spyros D. Mentzelopoulos
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Editors and Affiliations

  1. Department of Anesthesiology and Critical Care, Tettnang Hospital, Medizin Campus Bodensee, Tettnang, Germany

    Andrej Michalsen

  2. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital Harvard Medical School, Boston, MA, USA

    Nicholas Sadovnikoff

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Mentzelopoulos, S.D. (2020). Patients and Teams Caring for Them: Parallels Between Critical Care and Emergency Medicine. In: Michalsen, A., Sadovnikoff, N. (eds) Compelling Ethical Challenges in Critical Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-43127-3_2

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  • DOI: https://doi.org/10.1007/978-3-030-43127-3_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-43126-6

  • Online ISBN: 978-3-030-43127-3

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