BookAndrej Michalsen, Nicholas Sadovnikoff, editors.
Summary: This book addresses the ethical problems that physicians have to face every day while caring for critically ill patients. Advances in medical technology, ageing societies worldwide, and their increased demands on health care systems have, on the one hand, led to better care and remarkable longevity in many parts of the world. On the other hand, however, improved treatments in many medical fields, amongst others in emergency and critical care, have resulted in more patients surviving with reduced quality of life. This entails tradeoffs for many patients, their families, and the teams caring for them. At the same time, health care expenditures have risen dramatically and have to be balanced against costs for other public goods. Finally, the humane aspects of care have often failed to keep pace with the remarkable technological strides made in recent years. In this book, experts in their respective fields describe compelling ethical challenges resulting from these discrepancies and discuss potential solutions. The book is primarily intended for clinicians who care for two of the most vulnerable patient subpopulations - those being treated in ambulances or emergency rooms, and those being treated at intensive care units - due in part to the fact that they may be temporarily or permanently incapacitated. Core medical skills, such as diagnosis and predicting outcomes, as well as implementing treatment, remain challenging. However, without adequate communication and collaboration both within the inter-professional treatment teams and between the teams and the patients/their families, delivering excellent care is difficult at best. Therefore, the so-called "soft skills" are given the attention they deserve in order to overcome the gap between technological progress and interpersonal standstill.
Contents:
Intro
Foreword
Preface
Contents
About the Editors
Contributors
Part I: Introduction
1: How Ethics Can Support Clinicians Caring for Critically Ill Patients
1.1 Introduction
1.2 Background
1.3 Vignettes
1.4 Conclusion
References
2: Patients and Teams Caring for Them: Parallels Between Critical Care and Emergency Medicine
2.1 Introduction
2.2 Initial ED Care and Triage for ICU Admission
2.3 Ethical Challenges in the ED and ICU Settings
2.4 Vulnerable ED and ICU Patients
2.5 Challenges Associated with Surrogate Decision-Makers 2.6 Family Presence During Patient Care and Resuscitation
2.7 Advance Directives (AD), Advance Care Planning (ACP)
2.8 Shared Decision-Making
2.9 Equal Access to Best-Quality Care
2.10 Dignity and End-of-Life Care
2.11 Emergency/Critical Care Research Issues Besides Consent
2.12 Conclusions and Future Directions
References
Part II: Goal of Therapy, Teams and Patients
3: Indication and Prognostication
3.1 Introduction
3.2 Patient-Centered Indication and Prognostication
3.3 The Gap Between Attainable and Desirable Outcome
3.4 The Will of the Patient 3.5 Summary
References
4: Consent, Advance Directives, and Decision by Proxies
4.1 Introduction
4.2 Legal Bases
4.3 Informed Consent
4.3.1 Decisional Capacity or Competence
4.3.1.1 Assessing Capacity
4.3.1.2 How to Proceed When Patients Lack Capacity
4.3.2 Voluntariness
4.3.3 Information
4.3.4 Documentation
4.4 Advance Directives and Power of Attorney
4.4.1 Advance Directives (ADs)
4.4.1.1 Physician's Orders for Life-Sustaining Treatment (POLST)
4.4.1.2 Advanced Care Planning (ACP) 4.4.2 Durable Medical Power of Attorney for Health Care
4.4.3 Are ADs Valid, Applicable, and Legally Binding?
4.5 Ethical Challenges and Solutions in the Context of Emergency Medicine and Intensive Care
4.5.1 Emergencies
4.5.2 Barriers to Informed Consent in the ED/ICU
4.5.3 UN Convention on the Rights of Persons with Disabilities
4.5.4 Lack of ADs and Consequences for the Extent of Treatment
4.5.5 Availability of ADs
4.5.6 How to Make an Ethics-Based Decision
4.6 Conclusion
References
5: Cultural Diversity
5.1 Introduction 5.2 Caring for Critically Ill Patients
5.3 When Cultural Diversity Leads to Conflict
5.4 Conclusion
References
6: Interprofessional Shared Decision-Making
6.1 Introduction
6.2 Definitions and Evidence Base
6.3 Recommendations
6.4 Conclusions
References
7: Shared Decision-Making With Patients and Families
7.1 Introduction
7.2 The Relevance of Shared Decision-Making
7.3 Shared Decision-Making in Critically Ill Patients
7.4 Families in the ED and the ICU: Shared Decision-Making in a Context of High Emotional Distress
7.5 Impact of Shared Decision-Making on Families' Well-Being