Bench-to-bedside review: Ethical challenges for those in directing roles in critical care units

Robert W Sibbald,Neil M Lazar

doi:10.1186/cc2979

Abstract

Though much attention in the medical literature has focused on the ethics of critical care, it seems to be disproportionately weighted toward clinical issues. On the presumption that the operational management of an intensive care unit (ICU) also requires ethical considerations, it would be useful to know what these are. This review undertook to identify what literature exists with regard to the non-clinical issues of ethical importance in the ICU as encountered by clinician–managers. We found that in addition to issues of resource allocation, there exist many areas of ethical importance to clinician–managers in the ICU that have been described only superficially. We argue that a renewed focus on ICU ethics is merited to shed light on these other, non-clinical, issues.

Highlights

As a specialized field of philosophy, ethics has demanded that more institutions self-assess their actions so as to implement and maintain ethical practice
To identify publications that focused on ethical issues faced an ethical challenge for clinician–managers in critical care
Some articles were more dilemma and/or the ethical issue was strictly clinical in nature, detailed, and described dilemmas such as age-based not including the use of treatment policies because clinician– rationing [2] while still framing the question in terms of managers were considered to have a special interest in specific ethical principles and how they each affect the policy; that is, any intensive care unit (ICU) physician dealing with the issue was decision

Summary

Introduction

As a specialized field of philosophy, ethics has demanded that more institutions self-assess their actions so as to implement and maintain ethical practice (see the Additional file for definitions of ‘ethical practice’ and ‘ethics’). Technological and bureaucratic complexities have created dilemmas never before encountered, at least on the scale in which they occur. Nowhere are these two issues, a push to self-analyze critically and an increase in novel dilemmas, more present than in the intensive care unit (ICU). A cursory search of the phrase ‘critical care ethics’ in PubMed between 1966 and 2004 cited an impressive 1090 articles. Because a more focused search on ‘end of life ethics’ returned 986 articles, it seems that much of the published literature has a particular focus

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