scholarly journals Supporting Decision Making in Intensive Care: Ethical Principles for Managing Access to Care During the COVID-19 Pandemic

2021 ◽  
Vol 8 ◽  
Author(s):  
Stefano D'Errico ◽  
Martina Padovano ◽  
Matteo Scopetti ◽  
Federico Manetti ◽  
Martina Zanon ◽  
...  
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Access To Care ◽  
Healthcare Professionals ◽  
Ethical Issues ◽  
Health Resources ◽  
Ethical Considerations ◽  
Healthcare Resources ◽  
Health Threat ◽  
Critical Issues

The pandemic from COVID-19 causes a health threat for many countries and requires an internationally coordinated response due to the high spread of the infection. The current local and international situation gives rise to logistical and ethical considerations regarding the imbalance between needs for assistance and availability of health resources in the continuation of the emergency. A shortage condition will require healthcare professionals to choose between patients who will have access to respiratory support and those who will have to continue without. The sharing of criteria for the introduction of patients to the different therapeutic paths is fundamental to prevent the onset of ethical issues. The present paper analyzes the critical issues related to the scarcity of healthcare resources and the limitation of access to intensive care with the aim of proposing ethically sustainable principles for the management of the current pandemic situation.

Neonatal nurse practitioner ethics knowledge and attitudes

2018 ◽  
Vol 26 (7-8) ◽  
pp. 2247-2258
Author(s):  
Mobolaji Famuyide ◽  
Caroline Compretta ◽  
Melanie Ellis
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Nurse Practitioners ◽  
Neonatal Intensive Care ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Neonatal Nurse Practitioners

Background: Neonatal nurse practitioners have become the frontline staff exposed to a myriad of ethical issues that arise in the day-to-day environment of the neonatal intensive care unit. However, ethics competency at the time of graduation and after years of practice has not been described. Research aim: To examine the ethics knowledge base of neonatal nurse practitioners as this knowledge relates to decision making in the neonatal intensive care unit and to determine whether this knowledge is reflected in attitudes toward ethical dilemmas in the neonatal intensive care unit. Research design: This was a prospective cohort study that examined decision making at the threshold of viability, life-sustaining therapies for sick neonates, and a ranking of the five most impactful ethical issues. Participants and research context: All 47 neonatal nurse practitioners who had an active license in the State of Mississippi were contacted via e-mail. Surveys were completed online using Survey Monkey software. Ethical considerations: The study was approved by the University of Mississippi Medical Center Institutional Review Board (IRB; #2015-0189). Findings: Of the neonatal nurse practitioners who completed the survey, 87.5% stated that their religious practices affected their ethical decision making and 76% felt that decisions regarding life-sustaining treatment for a neonate should not involve consultation with the hospital’s legal team or risk management. Only 11% indicated that the consent process involved patient understanding of possible procedures. Participating in the continuation or escalation of care for infants at the threshold of viability was the top ethical issue encountered by neonatal nurse practitioners. Discussion: Our findings reflect deficiencies in the neonatal nurse practitioner knowledge base concerning ethical decision making, informed consent/permission, and the continuation/escalation of care. Conclusion: In addition to continuing education highlighting ethics concepts, exploring the influence of religion in making decisions and knowing the most prominent dilemmas faced by neonatal nurse practitioners in the neonatal intensive care unit may lead to insights into potential solutions.

Social and Ethical Concerns of Biomedical Engineering Research and Practice

2011 ◽  
pp. 54-80 ◽  
Author(s):  
Snehasish Mishra
Keyword(s):  
Decision Making ◽  
Biomedical Engineering ◽  
Healthcare Professionals ◽  
Ethical Issues ◽  
Healthcare Sector ◽  
Technological Advancement ◽  
Ethical Values ◽  
Medical Sciences ◽  
Engineering Research ◽  
Bioethical Issues

Biomedical engineering is an advanced and relatively new field in the healthcare sector. Owing to the very nature of the various professional challenges faced by healthcare professionals, the moral and ethical values seem to have taken the backburner. The factors contributing to it may include a sound knowledge of the healthcare professional on the legally-permissible ethical values, and the desperate situations requiring precise split-moment decision-making. No technological advancement without a human face is worth it, and hence, during the course of the degree, a biomedical engineering student needs to be exposed to various ethical issues through theory, live cases and demonstrations. Being intrinsically multi- and inter-disciplinary, biomedical engineering lacks precise ethical rules that delineate and delimit professional responsibility, thus blurring the ethical understanding of biomedical engineering. The solution seems to lie in giving due place to human virtues. In the coming days, bioethical issues are expected to be increasingly complicated and dominating the decision-making process owing to the advancements in sciences, and the ever-complicated cases handled by healthcare professionals. A global healthcare and ethics-related online open-access portal may serve as a common platform for all the stakeholders in the interest and ethical growth of biomedical engineering in particular and medical sciences in general.

Ethical Issues for Neonatal Nurses

1998 ◽  
Vol 5 (3) ◽  
pp. 206-217 ◽  
Author(s):  
Kaye Spence
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Ethical Decision ◽  
Clinical Decision Making ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Response Rate ◽  
Clinical Decision ◽  
Neonatal Nurses ◽  
Ethical Decisions

This article examines the involvement of neonatal nurses in ethical issues, achieved through a survey of Australian neonatal nurses. The aim was to discover if nurses were involved in ethical decisions, to examine various categories of neonates and the concerns that nurses felt about them, and to determine the extent to which nurses saw themselves as advocates. A response rate of 65% was achieved from nurses in two states who worked in intensive care and special care nurseries. The findings show that nurses were more likely to be involved in clinical decision making than in ethical decision making, showed the greatest concern for infants who had an uncertain prognosis, and saw themselves as advocates for their patients. The issues surrounding these findings are examined.

Healthcare Decision Making

2019 ◽  
pp. 41-56
Author(s):  
Haylee Lane ◽  
Jennifer M. Martin ◽  
Terry Haines
Keyword(s):  
Decision Making ◽  
Allied Health ◽  
Ad Hoc ◽  
Health Resources ◽  
Healthcare Decision ◽  
Healthcare Resources ◽  
Healthcare Decision Making ◽  
The World ◽  
Access And Equity ◽  
Decision Making Processes

The aim of this chapter is to explore the factors that health managers adopt when making decisions on how to allocate limited healthcare resources. The objective is to increase knowledge and understanding of decision making processes at the macro, meso, and micro levels and priority setting. An examination of current healthcare decision-making processes used for resource allocation around the world highlights the disparities in models and approaches and the often ad hoc nature of decisions made. A description of the allied health workforce highlights the size and significance of this workforce and why understanding decisions made in regards to allied health resources is of importance. Issues of access and equity are also considered in relation to notions of fairness and efficacy in relation to health outcomes.

scholarly journals Ethical and Clinical Aspects of Intensive Care Unit Admission in Patients with Hematological Malignancies: Guidelines of the Ethics Commission of the French Society of Hematology

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Sandra Malak ◽  
Jean-Jacques Sotto ◽  
Joël Ceccaldi ◽  
Philippe Colombat ◽  
Philippe Casassus ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Hematological Malignancies ◽  
Ethical Issues ◽  
Clinical Aspects ◽  
French Society ◽  
Initial Decision ◽  
Global Health Policy ◽  
Ethics Commission

Admission of patients with hematological malignancies to intensive care unit (ICU) raises recurrent ethical issues for both hematological and intensivist teams. The decision of transfer to ICU has major consequences for end of life care for patients and their relatives. It also impacts organizational human and economic aspects for the ICU and global health policy. In light of the recent advances in hematology and critical care medicine, a wide multidisciplinary debate has been conducted resulting in guidelines approved by consensus by both disciplines. The main aspects developed were (i) clarification of the clinical situations that could lead to a transfer to ICU taking into account the severity criteria of both hematological malignancy and clinical distress, (ii) understanding the process of decision-making in a context of regular interdisciplinary concertation involving the patient and his relatives, (iii) organization of a collegial concertation at the time of the initial decision of transfer to ICU and throughout and beyond the stay in ICU. The aim of this work is to propose suggestions to strengthen the collaboration between the different teams involved, to facilitate the daily decision-making process, and to allow improvement of clinical practice.

Evaluating ethical sensitivity in surgical intensive care nurses

2018 ◽  
Vol 26 (7-8) ◽  
pp. 2384-2397 ◽  
Author(s):  
Zehra Basar ◽  
Dilek Cilingir
Keyword(s):  
Intensive Care ◽  
Ethical Issues ◽  
Significance Test ◽  
Variance Analysis ◽  
Ethical Sensitivity ◽  
Ethical Considerations ◽  
Surgical Intensive Care ◽  
Intensive Care Nurses ◽  
The Difference ◽  
The Right

Background and aim: Surgical intensive care nurses should have ethical sensitivity allowing them to identify ethical issues in order that they can recognize them and make the right decisions. This descriptive study was conducted with the aim of evaluating the ethical sensitivity of surgical intensive care nurses. Materials and methods: The research was carried out with the participation of 160 nurses in six Turkish hospitals, four state, one university, and one private. The data were collected using the “Nurse Description Form” developed by the researcher and the “Ethical Sensitivity Questionnaire.” The percent, mean, standard deviation, median, minimum and maximum values, significance test for the difference between two means, variance analysis, Mann–Whitney U test, and Kruskal–Wallis Variance Analysis test were used to evaluate the data. Ethical considerations: Ethical commission permission and the corporate permission of the hospitals were received before conducting the research. Results: It was determined that the ethical sensitivities of surgical intensive care nurses were moderate based on the Ethical Sensitivity Questionnaire total score and subdimension score averages. A statistical difference was determined between the Ethical Sensitivity Questionnaire total score of surgical intensive care nurses and the institution where they worked, the period of working in the occupation, and the period of working in the intensive care unit (p < 0.05). Conclusion: Based on the results of the research, the organization of training and studies devoted to the elimination of ethical sensitivity differences between institutions and workers is suggested.

scholarly journals Ethical considerations about artificial intelligence for prognostication in intensive care

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Michael Beil ◽  
Ingo Proft ◽  
Daniel van Heerden ◽  
Sigal Sviri ◽  
Peter Vernon van Heerden
Keyword(s):  
Artificial Intelligence ◽  
Decision Making ◽  
Intensive Care ◽  
Prediction Models ◽  
Ethical Challenges ◽  
Ethical Considerations ◽  
Or Groups ◽  
Data Stewardship ◽  
Technical Refinement ◽  
Selection Of

Abstract Background Prognosticating the course of diseases to inform decision-making is a key component of intensive care medicine. For several applications in medicine, new methods from the field of artificial intelligence (AI) and machine learning have already outperformed conventional prediction models. Due to their technical characteristics, these methods will present new ethical challenges to the intensivist. Results In addition to the standards of data stewardship in medicine, the selection of datasets and algorithms to create AI prognostication models must involve extensive scrutiny to avoid biases and, consequently, injustice against individuals or groups of patients. Assessment of these models for compliance with the ethical principles of beneficence and non-maleficence should also include quantification of predictive uncertainty. Respect for patients’ autonomy during decision-making requires transparency of the data processing by AI models to explain the predictions derived from these models. Moreover, a system of continuous oversight can help to maintain public trust in this technology. Based on these considerations as well as recent guidelines, we propose a pathway to an ethical implementation of AI-based prognostication. It includes a checklist for new AI models that deals with medical and technical topics as well as patient- and system-centered issues. Conclusion AI models for prognostication will become valuable tools in intensive care. However, they require technical refinement and a careful implementation according to the standards of medical ethics.

scholarly journals Spatial Inequity in Access to Intensive Care Unit Beds at Regional Level in Italy

2021 ◽  
Author(s):  
Fabrizio Pecoraro ◽  
Daniela Luzi ◽  
Fabrizio Clemente
Keyword(s):  
Intensive Care ◽  
Health Resources ◽  
Spatial Accessibility ◽  
Policy Makers ◽  
Care Services ◽  
Regional Systems ◽  
Italian Regions ◽  
Short Period ◽  
Critical Issues ◽  
Reallocation Of Resources

The high demand of hospitalization in the intensive care units (ICUs) during the first wave of the COVID-19 outbreak brought out the critical issues of the limited capacity of the regional systems to deal with high patient inflows in a short period of time. In this view, a rapid and efficient reallocation of resources is one of the main challenges to be addressed by regional systems to prevent overload and saturation. Aim of this study is to assess the spatial accessibility of ICU beds in the 20 Italian regions to capture the equity distribution of critical care services across the country. This analysis may contribute to gain a deeper understanding of the allocation of health resources. It can provide input for policy makers in view of a possible reorganization of the national system in terms of both its preparedness for emergency period and routine capability.

scholarly journals Ethical Issues in Decision-making Regarding the Elderly Affected by Coronavirus Disease 2019: An Expert Opinion

2020 ◽  
Vol 15 ◽  
Author(s):  
David Martínez-Sellés ◽  
Helena Martínez-Sellés ◽  
Manuel Martínez-Sellés
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Healthcare Professionals ◽  
Preventive Measures ◽  
Ethical Issues ◽  
Good Clinical Practice ◽  
The Elderly ◽  
Chronological Age ◽  
Scarce Resources ◽  
Ethical Decisions

The coronavirus disease 2019 (COVID-19) pandemic is resulting in ethical decisions regarding resource allocation. Prioritisation reflects established practices that regulate the distribution of finite resources when demand exceeds supply. However, discrimination based on sex, race or age has no role in prioritisation unless clearly justified. The risk posed by COVID-19 is higher for elderly people than for younger people, so older adults should be prioritised in preventive measures. In the case of people who already have COVID-19, healthcare professionals might prioritise those most likely to survive. Making decisions based on chronological age alone is not justified; in addition to age, other aspects that determine theoretical life expectancy must be taken into account. Individualised correct prioritisation in the allocation of scarce resources is essential to good clinical practice.

scholarly journals THE INTERSECTION OF VULNERABILITY AND OLD AGE: ETHICAL CONSIDERATIONS FOR LONG-TERM SERVICES AND SUPPORTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S238-S238
Author(s):  
Kelly Niles-Yokum
Keyword(s):  
Older Adults ◽  
Old Age ◽  
Ethical Issues ◽  
Self Determination ◽  
Ethical Considerations ◽  
Critical Issues ◽  
Just Society ◽  
Services And Supports

Abstract This session focuses on ethical considerations in the context of long-term services and supports (LTSS) for vulnerable older adults. Long-term supports for vulnerable older adults can no longer adhere to a “one-sized fits all” solution. We will explore the intersection of vulnerability, old age, and community which present a myriad of ethical issues in both the planning and delivery of supports for older adults. The quest for a just society goes beyond understanding and considering the critical issues of the vulnerability of older adults in our society in that this pursuit provides a pathway to develop and implement programs and services that allow all of us the opportunity to live in a world that both protects and can provide the opportunity for self determination and dignity.

Sign in / Sign up

Export Citation Format

Share Document