End-of-life care for critically ill patients in the ICU and their families: Bioethical analysis

Abstract

Should Decision-making at the end of life in the ICU is a daily practice, in which the family and the team of health professionals are faced with conflicts and ethical dilemmas to decide the management of the patient in a clinical condition of irreversibility, so the bioethical framework must be taken into account in this process; Objectives; synthesize qualitative evidence of the experiences of the interprofessional team and the family in decision-making and care of patients in critical condition at the end of life in the framework of bioethics. Methods; Metaethnography following the proposal of Noblit and Hare. Structured equations were performed for the search. Participants' own expressions (first-order metaphors), the authors' interpretations or descriptions (second-order metaphors) and in order to create our own interpretations (third-order metaphors) were extracted; Results; In this study, 43 articles were included, from the relevant data of each study metaphors were extracted, analyzed from the bioethical framework and 3 categories and 13 subcategories emerged. The three categories are: Values, preferences and beliefs of the patient, family and health professionals at the end of life; Ethical conflicts at the end of life; and Decision-making process at the end of life. and Conclusions; Decision-making at the end of life in the ICU in patients with a clinical condition of irreversibility is influenced by the values ??and beliefs of the family and health professionals. Ethical conflicts arise when there is no agreement between the parties involved and between what should be done and what has to be done, establishing the need for frequent dialogue between the family and the interprofessional team to establish a consensus.