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Ethics consultations can help resolve conflicts that may prolong unwanted or nonbeneficial ICU treatments

Ethics consultations can help doctors, nurses, and patients/surrogates resolve conflicts that otherwise may inappropriately prolong nonbeneficial or unwanted treatments in the intensive care unit (ICU), according to a study supported by the Agency for Healthcare Research and Quality (HS10251). The researchers found that ethics consultations were associated with nearly 3 fewer hospital days and 1.5 fewer ICU days in those patients who ultimately did not survive to discharge.

The majority (87 percent) of physicians, nurses, and patients/surrogates agreed that ethics consultations in the ICU were helpful in addressing treatment conflicts. The consultation and usual-care groups showed no difference in patient mortality rates, allaying fears that ethics consultations would simply provide a subterfuge for "pulling the plug," notes Lawrence J. Schneiderman, M.D., of the University of California, San Diego.

Dr. Schneiderman and his colleagues compared the number of ICU days and hospital days, life-sustaining treatments, and mortality rates among ethics consult (278) and usual care (273) patients who had value-related treatment conflicts arise during the course of treatment at adult ICUs in seven U.S. hospitals. Physicians, nurses, and patients/surrogates were interviewed to obtain their views of the ethics consultation.

The ethics consultant framed the issues in easily understood ethical terms with the involved parties, drawing on relevant material, including hospital policy, published ethical consensus statements, statutes, and case law. At a minimum, the consultant addressed relevant medical factors, the patient's known or inferred values and preferences, quality of life considerations, and other contextual factors of importance. The consultant helped articulate consensus or disagreement and either helped implement the consensus or facilitated ways to address and resolve the disagreement.

See "Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting," by Dr. Schneiderman, Todd Gilmer, Ph.D., Holly D. Teetzel, M.A., and others, in the September 3, 2003, Journal of the American Medical Association 290(9), pp. 1166-1172.

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