Role of Clinical Ethicists in Making Decisions About Levels of Care in the Intensive Care Unit

Moral distress in critical care nurses: a phenomenological study

“…As was reported, numerous earlier quantitative studies have demonstrated that critical care nurses experience high levels of moral distress when providing treatments that are perceived as unnecessary (Pendry , Rice et al . , Faith & Chidwick , Radzvin , Haq , Özden et al . , Wilson et al .…”

How do healthcare professionals manage ethical challenges regarding information in healthcare professional/patient clinical interactions? A review of concept- or argument-based articles and case analyses

“…Year Type of study Journal Agyapong et al [38] 2009 Case review/analysis J Forensic Legal Med Bahal et al [48] 2010 Case review/analysis Int J Surgery Bell et al [45] 2015 Case review/analysis Pediatrics Beng [44] 2006 Case review/analysis Malays Fam Physician Chan Smutko et al [28] 2008 Case review/analysis Oncologist Cohen et al [55] 2012 Case review/analysis J Med Ethics Faith and Chidwick [42] 2009 Case review/analysis Crit Care Nurs Fine et al [20] 2005 Case review/analysis Pediatrics Gupta et al [60] 2008 Case review/analysis J Dev Behav Pediatr Hatano et al [52] 2011 Case review/analysis J Pain Symptom Manage Hyde et al [43] 2013 Case review/analysis Dimensions Crit Care Nurs Johnson et al [14] 2006 Case review/analysis Mil Med Kasman [34] 2004 Case review/analysis J Gen Intern Med Lohiya [37] 2013 Case review/analysis J Am Coll Dent Mueller et al [22] 2004 Case review/analysis Mayo Clin Proc Offit et al [29] 2004 Case review/analysis JAMA Olsen [51] 2010 Case review/analysis Am J Nurs Reynolds et al [23] 2007 Case review/analysis Surg Clin N Am Rinehart [56] 2013 Case review/analysis Clin Jam Soc Nephrol Schneider et al [30] 2006 Case review/analysis J Genet Couns Tully et al [19] 2016 Case review/analysis AMA J Ethics Umeorah and Chukwuneke [31] 2013 Case review/analysis Ann Med Health Sci Res Westra et al [35] 2009 Case review/analysis Eur J Pediatr White and Lofwall [57] 2015 Case review/analysis J Psychiatr Res Youngner [24] 2016 Case review/analysis AMA J Ethics Kadooka et al [26] 2016 Case review/analysis Bioethics Ercan Avci [12] 2017 Case review/analysis Med Health Care Philos Battistuzzi et al [27] 2012 Concept/argument-based article Clin Genet Becker et al [10] 2015 Concept/argument-based article J Pain Symptom Manage Brown [62] 2010 Concept/argument-based article Pediatr Radiol Brown et al [59] 2016 Concept/arg...…”

“…[40] In neonatology, conflicts between a physician's expert opinion and parental or family wishes regarding treatment, leading to communication breakdown, appear to be a constant source of ethical difficulties for health professionals. [41] Finally, in intensive-care units, some reviewed studies [19,42,43] identified difficulties in getting family members to appreciate the futility of treatment, and going ahead with treatment plans when the patient is ambivalent or indecisive, as two common challenges faced by professionals within this clinical context.…”

“…Studies report that some of the emotions professionals experience when they encounter these ethical challenges are anger, anxiety, frustration, exhaustion, depression, devastation, distress and guilt, to mention but a few, which could lead to burnout. [42,44,45] Strategies for managing these challenges Four themes for dealing with ethical difficulties regarding information emerged in this review: consultation; negotiating differences; using professional/prudential judgement; and trying to find resolution.…”

“…[58] This is a commonly suggested strategy for clinical situations where patients and professionals are motivated by different values; it can also be used to manage information when a patient is incapacited. For example, when family members -but not legal proxies -request a patient's confidential information, and the patient is incapacitated, some studies [42,43] suggest that critical-care nurses and/or mentalhealthcare professionals should carefully judge whether disclosure conforms with prevailing regulations or with the patient's advance directives (if any). The latter is important especially if the patient, before incapacitation, indicated that he/she did not want his/her family to know anything about his/her medical information.…”