Ethics in the ICU

Learning Objectives:

Knowledge:

• The importance of having clear goals for treatment in the ICU and the informed consent of the patient or his/her surrogate.
• An understanding of informed consent and refusal, the appropriate use of surrogate decision makers, the use of advanced directives, living wills, and durable power of attorney for health care and strategies for the resolution of ethical conflicts.
• Be able to articulate the distinction between killing and letting die and its relevance in the withholding and withdrawal of life-sustaining technology.
• When it is appropriate to use all available technology to sustain a life and when it is appropriate to limit treatment.
• The principle of justice and the use of resources in an intensive care setting.
• Differences in ethical decision making if the patient is an adult or a child.
• An awareness of ethical implications of common technologies used in the ICU (mechanical ventilation, artificial feeding and hydration, dialysis, etc.)

Skills:

• Be able to talk to a patient and/or his/her family regarding treatment plans, prognosis, and recommendations regarding treatment.
• Be able to discuss with a patient and/or family plans to institute, withhold, or withdraw life-sustaining technology.
• Analyze an ethical conflict and come up with a course of action that is morally defensible and medically reasonable.
• Assist patients and their families at time of critical illness with respect, concern for their dignity, and careful attention to pain control and suffering.

Attitudes:

• An awareness of the value of human life, regardless of the underlying illness of the patient.
• A recognition that illness and the informed wishes of the patient may modify the efforts made to nstitute or maintain life-sustaining therapy.
• As a Catholic institution, efforts directly intended to take the life of an individual are unacceptable at Loyola.
• As a Catholic institution, it is essential at Loyola to limit patient's pain and suffering, be expert in comfort care, and talk to the patient and/or his/her family about issues related to the person's care.
• The importance of developing a personal approach to ethical issues in the ICU to avoid unnecessary crises and be aware of one's own moral standards.
• It is essential to learn how to talk to patients and their families.

References:

1. Benitz WE. A paradigm for making difficult choices in the intensive care unit nursery. Chapter 16 in Thomasma D, Marshall P, (eds.) Clinical Medical Ethics Cases and Readings. Lanham, MD, University Press of America, 1995.
2. Sheehan MN. Ethical concerns in the care of the older person. Chapter 17 in Wei JY, Sheehan MN, (eds.) Geriatric Medicine: a case-based manual.
3. Oxford, UK: Oxford University Press, 1997.
4. Sheehan MN. Ethics of Patients In Crisis: The Intensive Care Unit.