Tuberc Respir Dis.  2015 Jul;78(3):175-179. 10.4046/trd.2015.78.3.175.

Ethics in the Intensive Care Unit

• Moon JY
• Kim JO

• KMID: 2320640
• DOI: http://doi.org/10.4046/trd.2015.78.3.175

Abstract

The intensive care unit (ICU) is the most common place to die. Also, ethical conflicts among stakeholders occur frequently in the ICU. Thus, ICU clinicians should be competent in all aspects for ethical decision-making. Major sources of conflicts are behavioral issues, such as verbal abuse or poor communication between physicians and nurses, and end-of-life care issues including a lack of respect for the patient's autonomy. The ethical conflicts are significantly associated with the job strain and burn-out syndrome of healthcare workers, and consequently, may threaten the quality of care. To improve the quality of care, handling ethical conflicts properly is emerging as a vital and more comprehensive area. The ICU physicians themselves need to be more sensitive to behavioral conflicts and enable shared decision making in end-of-life care. At the same time, the institutions and administrators should develop their processes to find and resolve common ethical problems in their ICUs.

Keyword

Ethics; Behavior; Terminal Care; Intensive Care Units

MeSH Terms

Administrative Personnel
Decision Making
Delivery of Health Care
Ethics*
Humans
Intensive Care Units*
Terminal Care

Reference

1. Aulisio MP, Arnold RM, Youngner SJ. Ethics consultation from theory to practice. Baltimore: The Johns Hopkins University Press;2003.

2. Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T, et al. Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med. 2004; 32:638–643.

3. Azoulay E, Timsit JF, Sprung CL, Soares M, Rusinova K, Lafabrie A, et al. Prevalence and factors of intensive care unit conflicts: the conflicus study. Am J Respir Crit Care Med. 2009; 180:853–860.

4. Hamric AB, Blackhall LJ. Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate. Crit Care Med. 2007; 35:422–429.

5. Pochard F, Darmon M, Fassier T, Bollaert PE, Cheval C, Coloigner M, et al. Symptoms of anxiety and depression in family members of intensive care unit patients before discharge or death. A prospective multicenter study. J Crit Care. 2005; 20:90–96.

6. Tapper EB, Vercler CJ, Cruze D, Sexson W. Ethics consultation at a large urban public teaching hospital. Mayo Clin Proc. 2010; 85:433–438.

7. Romano ME, Wahlander SB, Lang BH, Li G, Prager KM. Mandatory ethics consultation policy. Mayo Clin Proc. 2009; 84:581–585.

8. Park DW, Moon JY, Ku EY, Kim SJ, Koo YM, Kim OJ, et al. Ethical issues recognized by critical care nurses in the intensive care units of a tertiary hospital during two separate periods. J Korean Med Sci. 2015; 30:495–501.

9. Swetz KM, Crowley ME, Hook C, Mueller PS. Report of 255 clinical ethics consultations and review of the literature. Mayo Clin Proc. 2007; 82:686–691.

10. Saxton R, Hines T, Enriquez M. The negative impact of nurse-physician disruptive behavior on patient safety: a review of the literature. J Patient Saf. 2009; 5:180–183.

11. Sofield L, Salmond SW. Workplace violence: a focus on verbal abuse and intent to leave the organization. Orthop Nurs. 2003; 22:274–283.

12. Rosenstein AH. Original research: nurse-physician relationships: impact on nurse satisfaction and retention. Am J Nurs. 2002; 102:26–34.

13. Smetzer JL, Cohen MR. Intimidation: practitioners speak up about this unresolved problem. Jt Comm J Qual Patient Saf. 2005; 31:594–599.

14. Rosenstein AH, O'Daniel M. Impact and implications of disruptive behavior in the perioperative arena. J Am Coll Surg. 2006; 203:96–105.

15. Weber DO. Poll results: doctors' disruptive behavior disturbs physician leaders. Physician Exec. 2004; 30:6–14.

16. Rosenstein AH, O'Daniel M. Disruptive behavior and clinical outcomes: perceptions of nurses and physicians. Am J Nurs. 2005; 105:54–64.

17. Veltman LL. Disruptive behavior in obstetrics: a hidden threat to patient safety. Am J Obstet Gynecol. 2007; 196:587e1–e4.

18. The Joint Commission. Behaviors that undermine a culture of safety [Internet]. The Joint Commission;cited 2008 Nov 26. Available from: http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm.

19. Merlani P, Verdon M, Businger A, Domenighetti G, Pargger H, Ricou B, et al. Burnout in ICU caregivers: a multicenter study of factors associated to centers. Am J Respir Crit Care Med. 2011; 184:1140–1146.

20. Poncet MC, Toullic P, Papazian L, Kentish-Barnes N, Timsit JF, Pochard F, et al. Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med. 2007; 175:698–704.

21. Embriaco N, Azoulay E, Barrau K, Kentish N, Pochard F, Loundou A, et al. High level of burnout in intensivists: prevalence and associated factors. Am J Respir Crit Care Med. 2007; 175:686–692.

22. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002; 136:358–367.

23. Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008; 336:488–491.

24. Kang JH, Kim CW. Evaluating applicability of Maslach burnout Inventory among university hospitals nurses. Korean J Adult Nurs. 2012; 24:31–37.

25. Poghosyan L, Aiken LH, Sloane DM. Factor structure of the Maslach burnout inventory: an analysis of data from large scale cross-sectional surveys of nurses from eight countries. Int J Nurs Stud. 2009; 46:894–902.

26. Schroder C, Heyland D, Jiang X, Rocker G, Dodek P. Canadian Researchers at the End of Life Network. Educating medical residents in end-of-life care: insights from a multicenter survey. J Palliat Med. 2009; 12:459–470.

27. Park SH, Koh YS. Attitudes toward medical ethics among resident physicians in one Korean University Hospital. Korean J Med Ethics. 2007; 10:109–116.

28. Schernhammer ES, Colditz GA. Suicide rates among physicians: a quantitative and gender assessment (meta-analysis). Am J Psychiatry. 2004; 161:2295–2302.

29. Hawley G. Ethics in clinical practice: an interprofessional approach. Edinburgh: Pearson Education;2007. p. 45–49.

30. Steinhauser KE, Christakis NA, Clipp EC, McNeilly M, McIntyre L, Tulsky JA. Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA. 2000; 284:2476–2482.

31. Yun YH, Kwon YC, Lee MK, Lee WJ, Jung KH, Do YR, et al. Experiences and attitudes of patients with terminal cancer and their family caregivers toward the disclosure of terminal illness. J Clin Oncol. 2010; 28:1950–1957.

32. Back AL, Arnold RM. Discussing prognosis: "how much do you want to know?" talking to patients who are prepared for explicit information. J Clin Oncol. 2006; 24:4209–4213.

33. Yun YH, Kwak M, Park SM, Kim S, Choi JS, Lim HY, et al. Chemotherapy use and associated factors among cancer patients near the end of life. Oncology. 2007; 72:164–171.

34. Yun YH, Lee MK, Kim SY, Lee WJ, Jung KH, Do YR, et al. Impact of awareness of terminal illness and use of palliative care or intensive care unit on the survival of terminally ill patients with cancer: prospective cohort study. J Clin Oncol. 2011; 29:2474–2480.

35. Lee JK, Keam B, An AR, Kim TM, Lee SH, Kim DW, et al. Surrogate decision-making in Korean patients with advanced cancer: a longitudinal study. Support Care Cancer. 2013; 21:183–190.

36. Piers RD, Azoulay E, Ricou B, Dekeyser Ganz F, Decruyenaere J, Max A, et al. Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. JAMA. 2011; 306:2694–2703.

37. Sharma G, Freeman J, Zhang D, Goodwin JS. Trends in end-of-life ICU use among older adults with advanced lung cancer. Chest. 2008; 133:72–78.

38. Hwang KE, Seol CH, Hwang YR, Jo HG, Park SH, Yoon KH, et al. The prognosis of patients with lung cancer admitted to the medical intensive care unit. Asia Pac J Clin Oncol. 2013; 12. 02. [Epub]. DOI: 10.1111/ajco.12157.

39. Thompson DR, Kaufman D. Critical care ethics: a practice guide. 3rd ed. Mount Prospect: Society of Critical Care Medicine;2014.

40. Truog RD, Campbell ML, Curtis JR, Haas CE, Luce JM, Rubenfeld GD, et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of Critical Care Medicine. Crit Care Med. 2008; 36:953–963.

41. Longo DL, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Harrison's principles of internal medicine. 18th ed. New York: McGrawHill Medical;2012.