Compelling Ethical Challenges in Critical Care and Emergency Medicine

This book addresses the ethical problems that physicians have to face every day while caring for critically ill patients. Advances in medical technology, ageing societies worldwide, and their increased demands on health care systems have, on the one hand, led to better care and remarkable longevity in many parts of the world. On the other hand, however, improved treatments in many medical fields, amongst others in emergency and critical care, have resulted in more patients surviving with reduced quality of life. This entails tradeoffs for many patients, their families, and the teams caring for them. At the same time, health care expenditures have risen dramatically and have to be balanced against costs for other public goods. Finally, the humane aspects of care have often failed to keep pace with the remarkable technological strides made in recent years. In this book, experts in their respective fields describe compelling ethical challenges resulting from these discrepancies and discuss potential solutions. The book is primarily intended for clinicians who care for two of the most vulnerable patient subpopulations - those being treated in ambulances or emergency rooms, and those being treated at intensive care units - due in part to the fact that they may be temporarily or permanently incapacitated. Core medical skills, such as diagnosis and predicting outcomes, as well as implementing treatment, remain challenging. However, without adequate communication and collaboration both within the inter-professional treatment teams and between the teams and the patients/their families, delivering excellent care is difficult at best. Therefore, the so-called "soft skills" are given the attention they deserve in order to overcome the gap between technological progress and interpersonal standstill.

Auteur
Andrej Michalsen, MD, MPH, was born 1957 in Überlingen/See, Germany. He received his medical training at Kiel, Freiburg and Tübingen Universities as well as at the University of Texas School of Public Health in Houston, TX, U.S.A., and he has worked at the academic hospitals of Mainz, Germany, and Utrecht, the Netherlands. He is currently a consultant in Anaesthesiology and Critical Care at Tettnang Hospital, Germany, and the chair of the Ethics Committee there. He is a member of the Section on Ethics of the European Society of Intensive Care Medicine (which he chaired from 2013 to 2016), a member of the Ethics Section of the German Interdisciplinary Association of Intensive Care and Emergency Medicine, and a member of the Ethics and Conflict of Interest Committee of the American Thoracic Society. He also chaired the Subcommittee on Ethics of the annual German Anaesthesiology Congress from 2017 to 2020. His main areas of interest are focused on ethical issues in health care delivery and end-of-life care.

Dr. Sadovnikoff obtained his medical degree from Brown University in 1984. He has been on the Critical Care Anesthesia and Thoracic Anesthesia faculty at Brigham and Women's Hospital (BWH) and Harvard Medical School since 1998. He is board-certified in Internal Medicine, Critical Care Medicine and Anesthesiology, and is the Co-Director of the Surgical Intensive Care Units as well as program director of the BWH Fellowship in Anesthesiology Critical Care. He was inducted as a fellow in the American College of Critical Care Medicine (FCCM) in 2008. In 2008-9, he completed the Fellowship in Medical Ethics at Harvard Medical School and is of the faculty of the Harvard Center of Bioethics. He currently serves as Co-Chair of the BWH Ethics Committee, is an active member of the BWH Ethics Consultation Service and has achieved certification in Healthcare Ethics Consultation (HEC-C). His major areas of interest include advance care planning and end-of-life care, ethics of organ donation and transplantation, and informed consent and surrogate decision-making.

Contenu
Foreword.- Preface.- Part I Introduction.- How ethics can support clinicians caring for critically ill patients.- Patients and teams caring for them: parallels between critical care and emergency medicine.- Part II Goal of therapy, teams and patients.- Indication and prognostication.- Consent, advance directives, and decisions by proxies.- Cultural diversity.- Inter-professional shared decision-making.- Shared decision-making with patients and families.- Part III Extent of treatment.- Triage.- Usage of cutting edge technology: eCPR.- Usage of cutting edge technology: ECMO.- Limiting life-sustaining therapies.- Advancing palliative care in intensive care and emergency medicine.- Organ donation and transplantation.- Part IV Disproportionate care.- Disproportionate care, ethical climate and burnout.- Part V The way ahead.- Chapter 15.To treat or not to treat: How to arrive at an appropriate decision under critical circumstances?.- Epilogue.