Ethical and legal aspects in Critical Care and Ethical Principles


Ethical and legal aspects
Ethics: An area of study that deals with ideas about what is good and bad behavior : a branch of philosophy dealing with what is right or wrong
Rules of behavior based on ideas about what is morally good and bad
Selected Ethical and Legal issues
1. Informed consent
Consent problems arise because patients are experiencing acute, life threatening illness that interfere their ability to make decisions.
The doctrine of the informed consent is based on the principle of autonomy
Patients providing informed consent should be free from severe pain and depression
2. Decisions regarding life-sustaining treatment
Care of persons who are terminally ill or in a persistent vegetative state raises profound questions about the constitutional rights of persons or surrogates to make   the decisions related to death or life sustaining care.
Ordinary care and extra ordinary care.
Cardiopulmonary effort:
How long should resuscitation effort continue?
According to AHA 2000, health care providers may stop resuscitation when 30 minutes(for adults and children) and 15 minutes (newborn) of ACLS have been attempted without  restoration of breathing or heartbeat.
DNR (Do Not Resuscitate):
If the physician determines the resuscitation to be futile or has discussed the situation with patient, family and/or surrogate as appropriate and if there is mutual agreement not resuscitate in case of cardiopulmonary arrest.
Withholding or withdrawal of life support:
It can range from not initiating hemodialysis (withholding) to terminal weaning from mechanical ventilation (withdrawal).
Health care team or the family can initiate communication regarding withdrawing or withholding the life support.
Key points to keep in mind are
Communicate frequently throughout the critical stay, not just when death is imminent.
Provide consistent, honest information. Ensure all health care providers are giving same information.
Keep the discussion on withdrawing and withholding of life support based on the patient's wishes and burdens versus benefits of the various options.

3.End of life issues:
Advance Directives: It is a communication that specifies a person's preference about medical treatment should he or she become incapacitated
Living will provides a mechanism by which a person diagnosed with a terminal illness can authorize which specific treatments can be withheld in the event that he or she becomes incapacitated.
With the durable power of attorney for health care, patients legally designate an agent whom they trust, such as family member or friend; to make decisions on their behalf should they become incapacitated.
This person is called the health care surrogate or proxy
Promoting good death:
4.Organ and tissue transplantation: final consent for donation by patient, family or surrogate  
Organ and tissue removal should be performed only in donors who meet the legal definition for brain death.
5.Euthanasia: person killing another person without causing pain.
Other legal issues
Negligence: Failure to act as an ordinarily prudent person under similar circumstances.
Malpractice: failure to meet the requisite standard of care
Assault: Any intentional act which creates reasonable apprehension of immediate harmful or offensive contact with the plaintiff.
Eg patient fears offensive touching, or touching without taking consent.
Battery: Any intentional act that brings about actual or harmful or offensive contact with the plaintiff/applicant eg. operating on unauthorized body part, removing wrong limb.
Assessment failures
Planning failures
Implementation failures
Evaluation failures

Ethical principles
Justice/ allocation of resources  
Autonomy: Freedom to make decisions about one's own body without the coercion or interference of others.
Beneficence: Taking positive, active step to help others. In approaching issues related to beneficence
Nonmaleficence: Principle of Nonmaleficence which dictates that one prevents harm and correct harmful situations.
Veracity : Veracity or truth telling
Fidelity : Fidelity, or faithfulness and promise keeping to patients.
Confidentiality: It is a right whereby patient information can be shared only to those involved in the care of the patient.
Privacy: Maintaining privacy for the patient by pulling the curtains around the bed or making sure that the patient is adequately covered
Justice: It is concerned primarily with divided or portioned allocation of goods and services which is termed distributive justice.



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item Ethical and legal aspects in Critical Care and Ethical Principles
Ethical and legal aspects in Critical Care and Ethical Principles
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