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An overview of moral distress and the paediatric intensive care team.

https://arctichealth.org/en/permalink/ahliterature153537
Source
Nurs Ethics. 2009 Jan;16(1):57-68
Publication Type
Article
Date
Jan-2009
Author
Wendy Austin
Julija Kelecevic
Erika Goble
Joy Mekechuk
Author Affiliation
University of Alberta, Edmonton, AB, Canada. wendy.austin@ualberta.ca
Source
Nurs Ethics. 2009 Jan;16(1):57-68
Date
Jan-2009
Language
English
Publication Type
Article
Keywords
Canada
Conflict (Psychology)
Decision Making - ethics
Humans
Infant
Infant, Newborn
Intensive Care Units, Pediatric - ethics
Life Support Care - ethics
Patient Care Team - ethics
Pediatric Nursing - ethics
Stress, Psychological
Abstract
A summary of the existing literature related to moral distress (MD) and the paediatric intensive care unit (PICU) reveals a high-tech, high-pressure environment in which effective teamwork can be compromised by MD arising from different situations related to: consent for treatment, futile care, end-of-life decision making, formal decision-making structures, training and experience by discipline, individual values and attitudes, and power and authority issues. Attempts to resolve MD in PICUs have included the use of administrative tools such as shift worksheets, the implementation of continuing education, and encouragement to report. The literature does not yet show these approaches to be effective in the resolution of MD. The need to acknowledge MD among PICU teams is discussed and an argument made that, to facilitate understanding among team members, practice stories need to be shared.
PubMed ID
19103691 View in PubMed
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Are end-of-life practices in Norway in line with ethics and law?

https://arctichealth.org/en/permalink/ahliterature263426
Source
Acta Anaesthesiol Scand. 2014 Oct;58(9):1146-50
Publication Type
Article
Date
Oct-2014
Author
R. Førde
O G Aasland
Source
Acta Anaesthesiol Scand. 2014 Oct;58(9):1146-50
Date
Oct-2014
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Attitude of Health Personnel
Euthanasia - ethics - legislation & jurisprudence - statistics & numerical data
Female
Humans
Life Support Care - ethics - legislation & jurisprudence - statistics & numerical data
Male
Middle Aged
Norway
Physicians - ethics - legislation & jurisprudence - statistics & numerical data
Questionnaires
Sex Distribution
Suicide, Assisted - ethics - legislation & jurisprudence - statistics & numerical data
Terminal Care - ethics - legislation & jurisprudence - statistics & numerical data
Abstract
End-of-life decisions, including limitation of life prolonging treatment, may be emotionally, ethically and legally challenging. Euthanasia and physician-assisted suicide (PAS) are illegal in Norway. A study from 2000 indicated that these practices occur infrequently in Norway.
In 2012, a postal questionnaire addressing experience with limitation of life-prolonging treatment for non-medical reasons was sent to a representative sample of 1792 members of the Norwegian Medical Association (7.7% of the total active doctor population of 22,500). The recipients were also asked whether they, during the last 12 months, had participated in euthanasia, PAS or the hastening of death of non-competent patients.
Seventy-one per?cent of the doctors responded. Forty-four per?cent of the respondents reported that they had terminated treatment at the family's request not knowing the patient's own wish, doctors below 50 and anaesthesiologists more often. Anaesthesiologists more often reported to have terminated life-prolonging treatment because of resource considerations. Six doctors reported having hastened the death of a patient the last 12 months, one by euthanasia, one by PAS and four had hastened death without patient request. Male doctors and doctors below 50 more frequently reported having hastened the death of a patient.
Forgoing life-prolonging treatment at the request of the family may be more frequent in Norway that the law permits. A very small minority of doctors has hastened the death of a patient, and most cases involved non-competent patients. Male doctors below 50 seem to have a more liberal end-of-life practice.
PubMed ID
25124467 View in PubMed
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Artificial intelligence: making decisions about artificial nutrition and hydration.

https://arctichealth.org/en/permalink/ahliterature178789
Source
J Nutr Health Aging. 2004;8(4):254-6
Publication Type
Article
Date
2004

The case of Samuel Golubchuk and the right to live.

https://arctichealth.org/en/permalink/ahliterature144877
Source
Am J Bioeth. 2010 Mar;10(3):50-3
Publication Type
Article
Date
Mar-2010
Author
Alan Jotkowitz
Shimon Glick
Ari Z Zivotofsky
Author Affiliation
Ben-Gurion University of the Negev, Beer-Sheva, Israel. ajotkowitz@hotmail.com
Source
Am J Bioeth. 2010 Mar;10(3):50-3
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Canada
Choice Behavior - ethics
Cultural Characteristics
Decision Making - ethics
Dissent and Disputes
Enteral Nutrition - ethics
Ethics, Clinical
Ethics, Medical
Freedom
Health Care Rationing - ethics
Humans
Jews
Life expectancy
Life Support Care - ethics
Male
Manitoba
Medical Futility - ethics
Persistent Vegetative State
Personal Autonomy
Physician's Role
Practice Guidelines as Topic
Societies, Medical
Terminal Care - ethics - methods
Terminally ill
Value of Life
Withholding Treatment - ethics
Abstract
Samuel Golubchuk was unwittingly at the center of a medical controversy with important ethical ramifications. Mr. Golubchuk, an 84-year-old patient whose precise neurological level of function was open to debate, was being artificially ventilated and fed by a gastrostomy tube prior to his death. According to all reports he was neither brain dead nor in a vegetative state. The physicians directly responsible for his care had requested that they be allowed to remove the patient from life support against the wishes of the patient's family. Concurrently the Manitoba College of Physicians and Surgeons released a statement which states that the final decision to withdraw life support lies with the physician. In our opinion the statement is ethically problematic for a number of reasons. 1. It is an affront to the guiding principles of Western medical ethics: patient autonomy and human freedom. 2. The position of Samuel Golubchuk's physicians and the new statement lack cultural sensitivity towards other traditions. 3. In modern society there exists an erosion of a basic attitude towards the value of life. 4. The ability of physicians to predict life expectancy in terminally ill patients has been shown repeatedly to be quite limited.
Notes
Comment In: Am J Bioeth. 2010 Mar;10(3):56-720229423
Comment In: Am J Bioeth. 2010 Mar;10(3):54-620229422
Comment In: Am J Bioeth. 2010 Mar;10(3):67-820229429
Comment In: Am J Bioeth. 2010 Mar;10(3):64-520229427
Comment In: Am J Bioeth. 2010 Mar;10(3):61-320229426
Comment In: Am J Bioeth. 2010 Mar;10(3):W6-720229404
Comment In: Am J Bioeth. 2010 Mar;10(3):73-420229432
Comment In: Am J Bioeth. 2010 Mar;10(3):69-7020229430
Comment In: Am J Bioeth. 2010 Mar;10(3):58-920229424
Comment In: Am J Bioeth. 2010 Mar;10(3):65-620229428
Comment In: Am J Bioeth. 2010 Mar;10(3):59-6120229425
Comment In: Am J Bioeth. 2010 Mar;10(3):71-320229431
PubMed ID
20229421 View in PubMed
Less detail

The case of Samuel Golubchuk: the dangers of judicial deference and medical self-regulation.

https://arctichealth.org/en/permalink/ahliterature144874
Source
Am J Bioeth. 2010 Mar;10(3):59-61
Publication Type
Article
Date
Mar-2010

Clinical decisions without clinical judgment--when a philosophy of medicine is absent in the ICU.

https://arctichealth.org/en/permalink/ahliterature144873
Source
Am J Bioeth. 2010 Mar;10(3):61-3
Publication Type
Article
Date
Mar-2010
Author
William Harvey
Author Affiliation
University of Toronto, Toronto, Canada. william.harvey@utoronto.ca
Source
Am J Bioeth. 2010 Mar;10(3):61-3
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Cultural Characteristics
Decision Making - ethics
Ethics, Clinical
Ethics, Medical
Humans
Intensive Care Units - ethics - standards
Judgment
Life Support Care - ethics
Manitoba
Personal Autonomy
Philosophy, Medical
Physician's Role
Societies, Medical
Withholding Treatment - ethics
Notes
Comment On: Am J Bioeth. 2010 Mar;10(3):50-320229421
PubMed ID
20229426 View in PubMed
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[Concerning the Medical Society's new guidelines for life support care: let the current ethical decisions be valid].

https://arctichealth.org/en/permalink/ahliterature161867
Source
Lakartidningen. 2007 Jul 11-24;104(28-29):2096-7; discussion 2097-8
Publication Type
Article
Author
Susanne Ringskog Vagnhammar
Author Affiliation
Nationellt och Stockholms läns landstings centrum för suicidforskning och prevention av psykisk ohälsa, Stockholm. susanneringskogvagnhammar@msn.com
Source
Lakartidningen. 2007 Jul 11-24;104(28-29):2096-7; discussion 2097-8
Language
Swedish
Publication Type
Article
Keywords
Ethics, Medical
Humans
Life Support Care - ethics
Patient Rights - ethics
Physician's Role
Practice Guidelines as Topic
Resuscitation Orders - ethics
Societies, Medical
Sweden
Terminal Care - ethics
PubMed ID
17702387 View in PubMed
Less detail

Conversations about challenging end-of-life cases: ethics debriefing in the medical surgical intensive care unit.

https://arctichealth.org/en/permalink/ahliterature127578
Source
Dynamics. 2011;22(4):26-30
Publication Type
Article
Date
2011
Author
Cecilia Santiago
Steve Abdool
Author Affiliation
Critical Care Department, St. Michael's Hospital, Toronto, Ontario. santiagoc@smh.ca
Source
Dynamics. 2011;22(4):26-30
Date
2011
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Attitude to Death
Canada
Crisis Intervention
Female
Humans
Intensive Care Units
Life Support Care - ethics
Nursing Staff - ethics - psychology
Professional-Family Relations - ethics
Stress, Psychological - prevention & control
Terminal Care - ethics
Abstract
Clinicians frequently encounter and grapple with complex ethical issues and perplexing moral dilemmas in critical care settings. Intensive care unit (ICU) clinicians often experience moral distress in situations in which the ethically right course of action is intuitively known, but cannot be acted on. Most challenging cases pertain to end-of-life issues. Researchers have shown that moral distress and moral residue are common among critical care nurses. It is, therefore, essential that all ICU clinicians (and nurses, in particular) have an ongoing opportunity to work safely through these ethical dilemmas and conflicts. In this article, we describe the medical surgical intensive care unit (MSICU) experience with its monthly ethics initiative and explore the next steps to enhance its use through maximizing attendance and value to MSICU clinicians. To optimize attendance of staff a small group discussion among critical care clinicians (n = 8) was conducted asking about their perceptions of the debriefing sessions and their suggestions on how to promote their use. Process changes were implemented based on the group's suggestions. The process changes resulted in increased awareness of the benefits, increased frequency of sessions and demonstrated utility. Lessons learned from the MSICU experience will inform the development of education curricula to help critical care nurses with challenging end-of-life situations.
PubMed ID
22279847 View in PubMed
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Decisions to withhold or withdraw life-sustaining treatment in a Norwegian intensive care unit.

https://arctichealth.org/en/permalink/ahliterature262207
Source
Acta Anaesthesiol Scand. 2014 Mar;58(3):329-36
Publication Type
Article
Date
Mar-2014
Author
H. Hoel
S A Skjaker
R. Haagensen
K. Stavem
Source
Acta Anaesthesiol Scand. 2014 Mar;58(3):329-36
Date
Mar-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Documentation
Female
Hospital Mortality
Hospitals, University
Humans
Intensive Care - ethics
Intensive Care Units - ethics
Life Support Care - ethics
Male
Middle Aged
Norway
Referral and Consultation
Resuscitation Orders - ethics
Retrospective Studies
Treatment Outcome
Withholding Treatment - ethics
Abstract
To withhold and withdraw treatment are important and difficult decisions made in the intensive care unit (ICU). The aim of this study was to investigate the incidence of withholding or withdrawing treatment, characteristics of the patients, and how these decision processes were handled and documented in a general ICU from 2007 to 2009 in a university hospital in Norway.
Patient characteristics and outcomes of treatment were prospectively registered. We retrospectively reviewed the medical records for information on limitations in treatment.
In total, 1287 patients were admitted to the ICU. The ICU mortality was 208 (16%), and the hospital mortality was 341 (26%). In total, 301 patients (23%) had treatment withheld or withdrawn. Medical and unscheduled surgical patients with limitations in treatment had higher Simplified Acute Physiology Score II (P?
PubMed ID
24405518 View in PubMed
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46 records – page 1 of 5.