Symptoms of anxiety and depression in family members of intensive care unit patients: Ethical hypothesis regarding decision-making capacity

Abstract

More than two-thirds of family members visiting patients in the intensive care unit suffer from symptoms of anxiety or depression. Involvement of anxious or depressed family members in end-of-life decisions should be carefully discussed.

Research participants’ opinions of delayed consent for a randomised controlled trial of glucose control in intensive care

“…A list of eight alternative persons or organisations to make decisions on their behalf was provided and respondents ranked them from one to eight, according to their first preference. Characteristics derived from the literature included education level [12], language spoken at home [4], main activity before the ICU admission [14], the duration of the relationship with the substitute decision maker, whether previous discussions regarding participation in research had occurred [12] and one question regarding their general health [16].…”

“…The need for immediate treatment can mean that patients or their substitute decision makers do not have the time necessary to make informed decisions, and it can be difficult to access the substitute decision maker in time to enroll the patient into a clinical trial [1,2]. When available, substitute decision makers can be emotionally overwhelmed from the circumstances of the patient's illness and have been reported to experience anxiety, depression, and fatigue [3][4][5], such that they are unable to consider participation of the patient in research [6]. Delayed consent involves the enrolment of patients who lack decision making capacity into a clinical trial before obtaining consent.…”

“…Delayed consent to participate in the NICE-SUGAR study was obtained from participants (57/210; 27.1 %) or the substitute decision maker (152/210; 72. 4 …”

Brief review: Practice variation in end of life care in the ICU: implications for patients with severe brain injury

“…34 For families facing the impending death of a loved one, clinicians underestimate the levels of anxiety and depression that family members experience. 35 When death approaches and consideration of organ and tissue donation becomes a reality, how we interact with families may be a key determinant of how events proceed. It is crucially important to understand whether and how families wish to participate in decision-making.…”

Considering the vulnerabilities of surrogate decision-makers when obtaining consent for critical care research

“…In order to respect the ethical principle of autonomy, researchers commonly turn to substitute decision-makers (SDMs), for example, a spouse or other close relative, to obtain consent to conduct critical care research. However, these SDMs are often experiencing significant emotional strain and are also required to make decisions regarding medical treatment [1][2][3]. While most SDMs appear to want to participate in the research decision-making, this may add to the emotional burden of coping with a critically ill relative [4,5].…”