Death, Dying and Other Ethical Dilemmas

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Death, dying and other ethical dilemmas
Anand Chatoorgoon
University of Phoenix

Death, dying and other ethical dilemmas are issues that all Intensive Care Units (ICUs) throughout the world have to face and address. In the Current Opinion in Critical Care, Vol 16, No 6, December 2010, p. 640, Dixon-Woods and Bosk, writing on the topic of “Death, dying and other ethical dilemmas” under the journal’s section of ‘Ethical, legal and organizational issues in the ICU’, have stated that “Recent ethnographic work suggests that ethical dilemmas associated with end-of-life care in ICU clearly persist, even if clinicians are now more open about patients’ chances of surviving. An Australian study identified how decisions and actions made outside the ICU—such as proceeding with surgical procedures with very poor prognosis or admitting moribund patients who had sustained severe respiratory or cardiac arrest—led to a higher than expected rate of non-booked admissions. Staff believed these to be the result of futile interventions by staff outside the ICU that then resulted in ICU staff having to manage the patient and family through the dying process. ICU staff believed that this practice was detrimental to families by offering false hope of recovery, and that they were left to ‘clear up the unfinished work of medical staff’. Other studies have also documented the problems faced by staff confronted by patients whose potential for recovery is, at best, marginal, or when patients’ ‘significant others’ seek to influence ICU priorities and distribution of resources. Tensions exist between the critical care clinician’s view of the ICU as a place for caring for patients who can be salvaged, and an external view of the ICU as a place appropriate to send desperately ill, dying patients. Patients admitted to ICU despite ICU staff’s belief that they are not candidates for intensive care lead to role conflicts and other dilemmas for staff. The conflict is embedded in whom ICUs serve, the relative ease with which non-ICU clinicians can ‘turf’ their most critical patients to ICUs, the tensions ICU clinicians experience when delivering what they believe to be futile care, and the despair that family and clinicians share when having to abandon hope.”

This administrative ethics paper takes a look at the issues contained in the article of the aforementioned journal, Current Opinion in Critical Care, Vol 16, No 6, December 2010, and applies these issues to the situations faced by ICUs today and in particular, the ICU healthcare personnel at the 6-bedded ICU at the San-Fernando General Hospital (SFGH), a general multi-disciplinary 680-bedded hospital situated in the south of the island of Trinidad and which serves a catchment area of 600,000 people. Trinidad and Tobago is a twin-island republic in the West Indies, south of the archipelago with a population of 1.2 million people. The SFGH also has a 4-bedded HDU (high-dependency unit).

Brainstem death
The future plan for brain-dead patients whose hearts have been resuscitated by doctors in the Emergency Department (ED) of the SFGH following a cardiac and or respiratory arrest at home, poses an ethical dilemma for the healthcare personnel at the SFGH. Should these patients be admitted to the ICU which has only six beds to serve a population of 600,000? Shouldn’t these ICU beds be kept for patients with potentially reversible and salvageable pathology? Emergency physicians at the SFGH defend their decision to resuscitate such patients on the grounds that they cannot predict with any certainty which patients have reversible brain function and which do not. The present practice at the SFGH to provide ventilator support for these patients in the ED instead of the ICU while tests of brainstem function are being carried out, is frequently met with severe criticisms from relatives and loved ones who claim that the best is not being, and cannot be, done for such patients in the ED as opposed to...
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