ICU · Ethics, EOL & communication
Ethics, End-of-Life, Communication & Aeromedical Retrieval
Also known as Ethics and EOL · Four principles of bioethics · Capacity and consent · Limitation of treatment · Withholding and withdrawing · Breaking bad news · SPIKES · Family meeting · Brain death and organ donation · Aeromedical retrieval
The professional and the CanMEDS domain of the ICU — the four principles of the bioethics (the autonomy, the beneficence, the non-maleficence, the justice), the capacity and the informed consent (the components, the emergency exception, the substituted decision-maker, the advance directive), the end-of-life care and the limitation of the treatment (the withholding vs the withdrawing — the ethical equivalence, the futility, the goals-of-care), the breaking of the bad news (the SPIKES — the Setting, the Perception, the Invitation, the Knowledge, the Emotions, the Strategy), the shared decision-making and the family meeting, the specific ethics (the Jehovah's Witness, the brain death and the organ donation, the do-not-resuscitate), the medico-legal (the documentation, the open disclosure, the coroner), and the aeromedical retrieval (the scoop-and-run vs the stay-and-play, the time-critical, the team, the platform, the physiological stressors of the altitude, the temperature, the noise, the vibration and the gas expansion).
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An 82-year-old woman is ventilated in ICU for severe pneumonia after a cardiac arrest. Her CT brain shows a catastrophic hypoxic injury. The family asks you to "do everything." Your job is not to decide for them — it is to elicit who she was, communicate the prognosis honestly, and make a recommendation aligned with her values. The hardest intervention in critical care is the conversation.[3]
References26ShowHide
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