Report of 255 Clinical Ethics Consultations and Review of the Literature

Swetz, Keith M.; Crowley, Mary E.; Hook, C. Christopher; Mueller, Paul S.

doi:10.4065/82.6.686

Cited by 67 publications

(70 citation statements)

References 10 publications

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“…We report on the actual experiences of an ethics committee in a large ECMO referral center where physician, nursing, and ethics leadership made a conscientious decision to have ethics consultants routinely involved as the ECMO program expanded. We found that, rather than novel ethical dilemmas, the majority of consults involved very similar questionsincluding various permutations of disagreement between patients, surrogates, and health care professionals-posed in ethics consultations about other lifesustaining treatments (15). There were no cases in which the ethics committee was asked to comment specifically on the role of CPR in an ECMO patient, nor were there consults about whether ECMO should be an option for periarrest patients as imagined with extracorporeal CPR.…”

Section: Discussionmentioning

confidence: 88%

Ethics Committee Consultation and Extracorporeal Membrane Oxygenation

et al. 2016

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Rationale: The clinical ethics literature on extracorporeal membrane oxygenation (ECMO) has been focused primarily on identifying hypothetical ethical dilemmas that may arise with the use of this technology. Little has been written on the actual experience with ECMO-related ethical questions.Objectives: To describe the role of an ethics consultation service during the expansion of a single-center ECMO program in a cardiothoracic surgery intensive care unit (CSICU) and to identify common ethical themes surrounding the use of ECMO. Methods:We conducted a retrospective, descriptive cohort study of all ECMO ethics consultation cases in the CSICU at a large academic hospital between 2013 and 2015.Measurements and Main Results: During the study period, 113 patients were placed on ECMO in the CSICU, 45 (39.5%) of whom were seen by the ethics committee. In 2013, 10 of 46 (21.7%) patients received ethics consults. By 2015, 28 of 30 (93.3%) of patients were seen by ethics consultants. Initial consultation occurred at a median of 2 days (interquartile range, 1-6 d) following initiation of ECMO. The most common ethical issue involved disagreement about the ongoing use of ECMO, which included multiple axes: Disagreement among health care providers, disagreement among surrogates, and disagreement between health care providers and surrogates over stopping or continuing ECMO.Conclusions: In our experience with integrating ethics consultation into the routine care of ECMO patients, most of the ethical questions more closely resembled traditional concerns about the appropriate use of any life-sustaining treatment rather than the novel dilemmas imagined in the current literature.

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Section: Discussionmentioning

confidence: 88%

Ethics Committee Consultation and Extracorporeal Membrane Oxygenation

et al. 2016

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“…Several factors may account for this observation. First, we think that discussions, debate, ethics consultations, and scholarship (eg, lectures and publications 6,13 ) generated by requests to withdraw other life-sustaining treatments at our institution (eg, pacemaker and ICD support) informed our clinicians regarding the permissibility of meeting these requests. Nevertheless, in ambiguous situations, clinicians should consider ethics consultation.…”

Section: Discussionmentioning

confidence: 99%

“…Ethics consultations have been described in detail previously. 6 IllustratIve Case reports The following 7 case histories of patients who were part of the study group illustrate the clinical and psychosocial factors that may have affected decisions to withdraw VAD support. The case numbers correspond to the patient numbers in Tables 1 and 2.…”

Section: Methodsmentioning

confidence: 99%

Ethical Analysis of Withdrawing Ventricular Assist Device Support

Mueller

Swetz

Freeman

et al. 2010

Mayo Clinic Proceedings

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114

107

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OBJECTIVE: To describe a series of patients with heart failure supported with a ventricular assist device (VAD) who requested (or whose surrogates requested) withdrawal of VAD support and the legal and ethical aspects pertaining to these requests. PATIENTS AND METHODS:We retrospectively reviewed the medical records of patients at Mayo Clinic, Rochester, MN, from March 1, 2003, through January 31, 2009, who requested (or whose surrogates requested) withdrawal of VAD support and for whom the requests were fulfilled. We then explored the legal and ethical permissibility of carrying out such requests. RESULTS:The median age of the 14 patients identified (13 men, 1 woman) was 57 years. Requests were made by 2 patients and 12 surrogates. None of the patients' available advance directives mentioned the VAD. For 11 patients, multidisciplinary care conferences were held before withdrawal of VAD support. Only 1 patient had an ethics consultation. All 14 patients died within 1 day of withdrawal of VAD support. CONCLUSION:Patients have the right to refuse or request the withdrawal of any unwanted treatment, and we argue that this right extends to VAD support. We also argue that the cause of death in these cases is the underlying heart disease, not assisted suicide or euthanasia. Therefore, patients with heart failure supported with VADs or their surrogates may request withdrawal of this treatment. In our view, carrying out such requests is permissible in accordance with the principles that apply to withdrawing other life-sustaining treatments. Proc. 2010;85(9):791-797 AD = advance directive; BTT = bridge to (cardiac) transplant; DT = destination therapy; ICD = implantable cardioverter-defibrillator; LVAD = left VAD; VAD = ventricular assist device Mayo Clin

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“…In the qualitative first phase of the study, intensive care physicians were selected for the focus group interviews because they frequently encounter ethical dilemmas (20) and are involved in end-oflife decisions (14). There are nine intensive care units (ICU) in the HUHs.…”

Section: Qualitative Researchmentioning

confidence: 99%

Proposal for a Hospital Ethics Committee at the Hacettepe University Hospitals, Turkey: A Mixed Method Study

Demir¹,

Büken²

2016

Acta Med Anatol

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Introduction: Hospital Ethics Committees (HECs) were established to solve the ethical dilemmas experienced by health personnel in clinics. However, HECs also provide training on ethics, and develop ethics guidelines and institutional policies. HECs first appeared in the USA in the 1960s and had become widespread in Europe by the 1990s. In Turkey, the introduction of HECs is relatively recent and the number of committees is limited. The aim of this study was to identify the need for a HEC at the Hacettepe University Hospitals (HUHs) and to develop an appropriate model for the HEC. Methods:Both qualitative and quantitative research methods were used. As a part of the qualitative research, focus group interviews were conducted with physicians in the intensive care unit of the HUHs. Survey forms were prepared, with reference to the data, which were collected during these interviews. The quantitative research was conducted by distributing survey forms to all physicians working at the HUHs. Data were evaluated using SPSS v.11.5 software. Results: In total, 250 surveys were completed (participation ratio 25%). Physicians who participated in the research confirmed the need for an organization to provide training on ethics, to prepare ethics guidelines and to help solve ethical dilemmas. Conclusion: Here a model for a HEC is proposed, with reference to the needs and suggestions of the physicians who work at the HUHs. Keywords: Medical ethics, clinical ethics committee, hospital ethics committee, ethics consultation.

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Report of 255 Clinical Ethics Consultations and Review of the Literature

Cited by 67 publications

References 10 publications

Ethics Committee Consultation and Extracorporeal Membrane Oxygenation

Ethics Committee Consultation and Extracorporeal Membrane Oxygenation

Ethical Analysis of Withdrawing Ventricular Assist Device Support

Proposal for a Hospital Ethics Committee at the Hacettepe University Hospitals, Turkey: A Mixed Method Study

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