Skip to main content

How Ethics Can Support Clinicians Caring for Critically Ill Patients

  • Chapter
  • First Online:
Compelling Ethical Challenges in Critical Care and Emergency Medicine

Abstract

As a field, clinical ethics has made significant progress in the past 50 years. There is evidence, however, that ethical conflict and uncertainty are still major contributors to challenges faced in critical care and emergency medicine practice, resulting in stress on clinicians and potentially detrimental impacts on patient care. Additionally, as technology continues to progress and evolve, so do the ethical questions that arise. In this chapter, we begin by providing a brief background on clinical ethics. Then, using clinical vignettes, we examine the ways in which the tools of ethics can help the bedside clinician. For each case, we review general ethical frameworks and areas of consensus to which clinicians can turn for guidance. We also highlight ongoing challenges with the prevailing frameworks, and areas where there is still work to be done.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Carrese JA, Sugarman J. The inescapable relevance of bioethics for the practicing clinician. Chest. 2006;130:1864–72.

    Article  Google Scholar 

  2. World Medical Association. WMA International code of medical ethics. WMA Gen Assem 2006. Pilanesburg, South Africa; 2006.

    Google Scholar 

  3. International Council of Nurses. The ICN code of ethics for nurses. 2012. https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_%20eng.pdf. Accessed 22 Feb 2016.

  4. European Council of Medical Orders. Principles of European medical ethics. 2010. http://www.ceom-ecmo.eu/en/view/principles-of-european-medical-ethics. Accessed 22 Nov 2019.

  5. Grace P, Milliken A. Educating nurses for ethical practice in contemporary health care environments. Hast Cent Rep. 2016;46:S13–7.

    Article  Google Scholar 

  6. Hoskins K, Grady C, Ulrich CM. Ethics education in nursing: instruction for future generations of nurses. Online J Issues Nurs. 2018;23:1–19.

    Google Scholar 

  7. Cook A, Spars G, Black L, et al. Making ethics education matter: a novel approach for enhancing ethics education in a medical school. MedEdPublish. 2019;8:1–11.

    Google Scholar 

  8. Piers RD, Decruyenaere J, Depuydt P, et al. Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. JAMA. 2011;306:2694–703.

    Article  CAS  Google Scholar 

  9. Benoit DD, Jensen HI, Malmgren J, et al. Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA. Intensive Care Med. 2018;44:1039–49.

    Article  CAS  Google Scholar 

  10. Austin W. Contemporary healthcare practice and the risk of moral distress. Healthc Manage Forum. 2016;29:1–3.

    Google Scholar 

  11. Austin C, Saylor R, Finley P. Moral distress in physicians and nurses: impact on professional quality of life and turnover. Psychol Trauma. 2017;9:399–406.

    Article  Google Scholar 

  12. Dzeng E, Colaianni A, Roland M, et al. Moral distress amongst American physician trainees regarding futile treatments at the end of life: a qualitative study. J Gen Intern Med. 2016;31:93–9.

    Article  Google Scholar 

  13. Moss M, Good VS, Gozal D, et al. An official critical care societies collaborative statement. Crit Care Med. 2016;44:1414–21.

    Google Scholar 

  14. Beauchamp TL, Childress JF. Principles of biomedical ethics. 8th ed. New York: Oxford University Press; 2019.

    Google Scholar 

  15. Jonsen AR, Siegler M, Winslade WJ. Clinical ethics: a practical approach to ethical decisions in clinical medicine. New York: McGraw-Hill; 2010.

    Google Scholar 

  16. Sprung CL, Truog RD, Curtis JR, et al. Seeking worldwide professional consensus on the principles of end-of-life care for the critically ill: the consensus for worldwide end-of-life practice for patients in intensive care units (WELPICUS) study. Am J Respir Crit Care Med. 2014;190:855–66.

    Article  Google Scholar 

  17. Sullivan S. Medical maternalism: beyond paternalism and antipaternalism. J Med Ethics. 2016;42:439–44.

    Article  Google Scholar 

  18. Torke AM, Sachs GA, Helft PR, et al. Scope and outcomes of surrogate decision making among hospitalized older adults. JAMA Intern Med. 2014;174:370–7.

    Article  Google Scholar 

  19. Shalowitz DI, Garrett-Mayer E, Wendler D. The accuracy of surrogate decision makers. Arch Intern Med. 2006;166:493.

    Article  Google Scholar 

  20. Kon AA, Davidson JE, Morrison W, et al. 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 

  21. Carrese JA. Refusal of care: patients’ well-being and physicians’ ethical obligations: “but doctor, I want to go home.”. JAMA. 2006;296:691–5.

    Article  CAS  Google Scholar 

  22. Gedge E, Giacomini M, Cook D. Withholding and withdrawing life support in critical care settings: ethical issues concerning consent. J Med Ethics. 2007;33:215–8.

    Article  CAS  Google Scholar 

  23. Bosslet GT, Pope TM, Rubenfeld GD, et al. An official ATS/AACN/ACCP/ESICM/SCCM policy statement: responding to requests for potentially inappropriate treatments in intensive care units. Am J Respir Crit Care Med. 2015;191:1318–30.

    Article  Google Scholar 

  24. Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: its meaning and ethical implications. Ann Intern Med. 1990;112:949–54.

    Article  CAS  Google Scholar 

  25. Truog RD, Brett AS, Frader J. The problem with futility. N Engl J Med. 1992;326:1560–4.

    Article  CAS  Google Scholar 

  26. Helft PR, Siegler M, Lantos J. The rise and fall of the futility movement. N Engl J Med. 2000;343:293–5.

    Article  CAS  Google Scholar 

  27. Joseph R. Hospital policy on medical futility—does it help in conflict resolution and ensuring good end-of-life care? Ann Acad Med Singap. 2011;40:19–25.

    PubMed  Google Scholar 

  28. Bülow HH, Sprung CL, Baras M, et al. Are religion and religiosity important to end-of-life decisions and patient autonomy in the ICU? The ethicatt study. Intensive Care Med. 2012;38:1126–33.

    Google Scholar 

  29. Balboni TA, Vanderwerker LC, Block SD, et al. Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life. J Clin Oncol. 2007;25:555–60.

    Article  Google Scholar 

  30. Sprung L, Cohen SL, Sjokvist P, et al. End-of-life practices in European intensive care units: the Ethicus study. JAMA. 2003;290:790–7.

    Article  Google Scholar 

  31. Long AC, Brumback LC, Curtis JR, et al. Agreement with consensus statements on end-of-life care. Crit Care Med. 2019;47:1396–401.

    Article  Google Scholar 

  32. Lo B, Ruston D, Kates L, et al. Discussing religious and spiritual issues at the end of life: a practical guide for physicians. JAMA. 2002;287:749–54.

    Article  Google Scholar 

  33. 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 

  34. Reeves S, Perrier L, Goldman J, et al. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev. 2013;(3):CD002213.

    Google Scholar 

  35. Epstein EG, Whitehead PB, Prompahakul C, et al. Enhancing understanding of moral distress: the measure of moral distress for health care professionals. AJOB Empir Bioeth. 2019;10:113–24.

    Article  Google Scholar 

  36. Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med. 2004;79:186–94.

    Article  Google Scholar 

  37. Pavlish BCL, Brown-Saltzman K, Raho JA, et al. A national survey on moral obligations in critical care. Am J Crit Care. 2019;28:183–92.

    Article  Google Scholar 

  38. Michalsen A, Long AC, DeKeyser GF, et al. Interprofessional shared decision-making in the ICU: a systematic review and recommendations from an expert panel. Crit Care Med. 2019;47:1258–66.

    Article  Google Scholar 

  39. Hamric AB, Wocial LD. Institutional ethics resources: creating moral spaces. Hast Cent Rep. 2016;46:S22–7.

    Article  Google Scholar 

  40. Walker MU. Keeping moral space open: new images of ethics consulting. Hast Cent Rep. 1993;23:33–40.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Aimee B. Milliken .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Milliken, A.B., Sadovnikoff, N. (2020). How Ethics Can Support Clinicians Caring for Critically Ill Patients. 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_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-43127-3_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-43126-6

  • Online ISBN: 978-3-030-43127-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics