| Popis: |
Ethically complex issues are commonly encountered in critically ill patients in intensive care units and usually relate to disagreements about care in such high risk situations. Because the clinical course is often uncertain and unpredictable, serious disagreements about the plan and priorities of care occur. This is presented simplistically as a conflict between the (surrogate) autonomy of the family members and the physician (health care professional) authority, in promoting the patient’s best interests. The ethical issues emerge only when discussion includes broader concerns about morbidity, mortality, and meaning to family and the hospital staff. We review the theoretical ethical basis of decision-making in such situations in the context of neonatal intensive care units and recommend that the physician focuses on the professional role of advocate for the infant’s best interests. Reflective conversations with family, including openness about uncertainty and willingness to re-evaluate care plans, are essential to maintain trust. This mediation approach supports different moral views in an atmosphere of mutual respect. Expert ethics assistance early on in high risk cases is recommended. We suggest that this be provided by an ethics consulting service readily available to the staff for optimizing care and preventing the development of crises. |
