Bioethics in the Pediatric ICU: Ethical Dilemmas Encountered in the Care of Critically Ill Children

Abstract

The book series International Library of Ethics, Law and the New Medicine comprises volumes with an international and interdisciplinary focus. The aim of the Series is to publish books on foundational issues in (bio) ethics, law, international health care and medicine. The volumes that have already appeared in this series address aspects of aging, mental health, AIDS, preventive medicine, bioethics and many other current topics. This Series was conceived against the background of increasing globalization and interdependency of the world's cultures and governments, with mutual influencing occurring throughout the world in all fields, most surely in health care and its delivery. By means of this Series we aim to contribute and cooperate to meet the challenge of our time: how to aim human technology to good human ends, how to deal with changed values in the areas of religion, society, culture and the self-definition of human persons, and how to formulate a new way of thinking, a new ethic. We welcome book proposals representing the broad interest of the interdisciplinary and international focus of the series. We especially welcome proposals that address aspects of 'new medicine', meaning advances in research and clinical health care, with an emphasis on those interventions and alterations that force us to re-examine foundational issues.

Family conflict and aggression in the paediatric intensive care unit: Responding to challenges in practice

“…4 Defining the continuum of behaviours PICU HCPs regularly encounter a spectrum of challenging family behaviours. 11 Families have varying emotional and personality styles, as do clinicians 25 and these characteristics profoundly influence behavioural responses, particularly in high-stress situations. 14 Of note, we stipulate labelling only behaviours themselves as challenging to avoid negative attribution to the person or family themselves.…”

“…This emphasis has potentially diverted attention away from considering the acute impact of such conflict on HCPs themselves, except when moral distress ensues. 11,12 We examine this issue in the unique PICU context and propose reasons why its influence has been insufficiently weighted in the safety calculus. We outline a continuum of challenging behaviours encountered by PICU staff and reflect on some flow-on-effects of prioritising the familycentred model-of-care (FCC).…”

Nudging During Pediatric Intensive Care Conferences With Family Members: Retrospective Analysis of Transcripts From a Single-Center, 2015–2019*

“…In this context, shared decision-making (SDM) between clinicians and families has emerged as a response to medical paternalism, in which clinicians make decisions on behalf of patients (1). However, SDM can place families in the challenging position of making decisions without adequate guidance or knowledge (2) and requires comprehension of medicine (3). The complexity of decision-making in high-stakes situations has created a need for an approach that allows parental choice while providing guidance from clinicians.…”

“…Furthermore, SDM emphasizes the importance of incorporating a family's values and goals into the decision-making process. When these conversations go poorly, it can compromise patient care and lead to increased moral distress among healthcare providers and families (3).…”