Early Ethics Intervention in ICUs: Learning What Works

Patients in a hospital ICU present complex ethical challenges. Because 10% to 20% of ICU admissions can be expected to die during that admission or upon discharge to their next level of care (Zimmerman et al. Crit Care Med. 1998;26[8]:1317), staff can have difficulties shifting gears when all technically feasible care may no longer be clinically meaningful. Because the death rate is high, moral distress can take its emotional toll on staff (Hameric et al. Crit Care Med. 2007;35[2]:422), and communications with families can be conflicted. Families of ICU patients may lack trust, and an increasing subset of families want decisional control ( Johnson et al. [published online ahead of print Oct 29, 2010]. Am J Respir Crit Care Med. doi:10.1164/rccm.201008-1214OC).

Clinical ethicists may help prevent and resolve ethical complexities that produce conflict and distress through early ethics interventions (DeRenzo et al. HEC Forum. 2006;18[4]:319; DeRenzo et al. Camb Q Healthc Ethics. 2006;15[2]:207). Empiric data (Schneiderman et al. Crit Care Med. 2000;28[12]:3920; Schneiderman et al. JAMA. 2003;290[9]:1166) show that early ethics contact with families (Scheunemann et al. Chest. 2011; 139[30]:543) may reduce conflict and distress among families and clinicians.

To increase understanding of how early ethics intervention might reduce conflict and distress, we are beginning a project that will look at an array of variables that may predict ethics complexities and early ethics interventions that could reduce communication problems, reduce length of stay and, ultimately, reduce liability. As our clinical ethics hunches are supported or refuted, we will use these data to design future studies and early ethics interventions to contribute to improving the quality of critical care delivered at our hospital.

Nneka O. Mokwunye, PhD; and
Evan G. DeRenzo, PhD
Steering Committee Member