IMPACT OF ETHICS CONSULTATION IN THE INTENSIVE CARE UNIT

University Of California San Diego, La Jolla CA

Investigators

Linked publications & trials

Abstract

Background: Ethics consultations have been introduced into the practice of medicine during the past several decades as a way to help physicians, patients, families and intimate friends come to a decision about medical treatments where value conflicts are involved. Prospective empirical studies evaluating their impact, however, are limited. Proposed here is a randomized controlled trial of ethics consultations in the Intensive Care Units [ICU's] of 5 Clinical Centers representing a broad spectrum of characteristics, including community and academic institutions, in various locations of the United States: 1 on the east coast, 2 in the midwest and 2 on the west coast. Hypotheses: The outcome hypotheses to be tested are that ethics consultations in the intensive care setting will reduce non-beneficial treatment, i.e. ICU and hospital days and life- prolonging interventions and hospital costs in those patients who fail to survive to hospital discharge. The process hypotheses are: 90% of physicians and nurses, and 80% of patients/families/intimate friends will agree or strongly agree that ethics consultations in the ICU help to: i) identify ethical issues, 2) analyze ethical issues, 3) resolve ethical issues, 4) educate about ethical issues, and 5) present personal views. Methods: Patients in whom value-based treatment conflicts arise will be randomly assigned to an intervention (ethics consultation offered) or non- intervention (ethics consultation not offered) arm of the trial. Detailed medical data will be conducted with the responsible physicians, nurses, and patients/families/intimate friends within 1 month after the patient's death or hospital discharge. Significance: This study will help to determine the impact of ethics consultations are: 1) perceived to be beneficial, and 2) prove to be useful in resolving conflicts that may be inappropriately prolonging futile or unwanted and costly treatments.