Full Description
This book addresses the ethical problems that physicians have to face every day while caring for critically ill patients. Advances in medical technology, ageing societies worldwide, and their increased demands on health care systems have, on the one hand, led to better care and remarkable longevity in many parts of the world. On the other hand, however, improved treatments in many medical fields, amongst others in emergency and critical care, have resulted in more patients surviving with reduced quality of life. This entails tradeoffs for many patients, their families, and the teams caring for them. At the same time, health care expenditures have risen dramatically and have to be balanced against costs for other public goods. Finally, the humane aspects of care have often failed to keep pace with the remarkable technological strides made in recent years.
In this book, experts in their respective fields describe compelling ethical challenges resulting from these discrepancies and discuss potential solutions. The book is primarily intended for clinicians who care for two of the most vulnerable patient subpopulations - those being treated in ambulances or emergency rooms, and those being treated at intensive care units - due in part to the fact that they may be temporarily or permanently incapacitated. Core medical skills, such as diagnosis and predicting outcomes, as well as implementing treatment, remain challenging. However, without adequate communication and collaboration both within the inter-professional treatment teams and between the teams and the patients/their families, delivering excellent care is difficult at best. Therefore, the so-called "soft skills" are given the attention they deserve in order to overcome the gap between technological progress and interpersonal standstill.
Contents
Foreword.- Preface.- Part I Introduction.- How ethics can support clinicians caring for critically ill patients.- Patients and teams caring for them: parallels between critical care and emergency medicine.- Part II Goal of therapy, teams and patients.- Indication and prognostication.- Consent, advance directives, and decisions by proxies.- Cultural diversity.- Inter-professional shared decision-making.- Shared decision-making with patients and families.- Part III Extent of treatment.- Triage.- Usage of cutting edge technology: eCPR.- Usage of cutting edge technology: ECMO.- Limiting life-sustaining therapies.- Advancing palliative care in intensive care and emergency medicine.- Organ donation and transplantation.- Part IV Disproportionate care.- Disproportionate care, ethical climate and burnout.- Part V The way ahead.- Chapter 15.To treat or not to treat: How to arrive at an appropriate decision under critical circumstances?.- Epilogue.
