Ethics in Intensive Care Medicine

In this book, part of the European Society of Intensive Care Medicine (ESICM) textbook series, experts in the field of clinical ethics describe basic principles of clinical ethics and ethical reasoning, the fundamental pillars of intensive care medicine as well as the decision-making processes necessary to arrive at appropriate decisions for each individual patient. Specifically, the complex decision-making process, with regard to limiting life-sustaining therapies and integrating palliative care into intensive care, are expounded. Furthermore, the still controversial topics of ethical climate, proportionate care, and prioritization are elaborated upon. The so-called “soft skills” of inter-professional communication and co-operation are given the attention they deserve in order to overcome the gap between technological progress and interpersonal standstill. Finally, widely accepted ethical values and principles were challenged by the Covid-19 pandemic, forcing clinicians to elaborate recommendations regarding the prioritization of scarce resources.

The book will be an invaluable tool for clinicians to understand ethical principles and reasoning to contend ethical challenges in intensive care medicine across the boundaries of disciplines and professions, in order to provide an appropriate individual plan of treatment for their patients.

Foreword.- Preface.- Part I. Principles of clinical ethics in intensive care medicine.- Clinical ethics and ethical principles.- The two pillars of intensive care medicine (I): Indication.- The two pillars of intensive care medicine (II): The Patient’s Wishes and Consent.- Part II. Decision-making.- Inter-professional shared decision-making.- Shared decision-making with patients and families.- Cultural diversity.- Part III.- Goal of therapy and extent of treatment.- Life-sustaining therapies: indication, prognostication, and the patient’s wishes.- Limiting life-sustaining therapies.- Focus topic: resuscitation in the ICU.- Palliative care in the intensive care unit.- Part IV – Appropriateness of care Ethical climate and proportionate care.- Clinical ethics and the law.- Distributive Justice: Ethics during health care crises.- Part V – Ethics in the ICU: The way ahead.- Making choices in uncertainty. Educating clinicians in clinical ethics.

Series Editors

Prof. Maurizio Cecconi is Head of Department Anaesthesia and Intensive Care Units, IRCCS Istituto Clinico Humanitas, Rozzano (MI), Italy and Professor of Anaesthesia and Intensive Care, Humanitas University, Pieve Emanuele (MI), Italy. His main fields of research are haemodynamic monitoring, haemodynamic optimisation and physiology of the critically ill patient. He has published extensively and has specific interest in haemodynamic monitoring and fluid management of the critically ill.

Prof. Daniel De Backer is Professor of Intensive Care at the Université Libre de Bruxelles, Brussels, Belgium Head of Intensive Care Departments of CHIREC Hospitals (Brussels and Braine l’Alleud-Waterloo). His main fields of investigation are severe sepsis, organ dysfunction, acute circulatory failure and its treatment (in particular vasoactive agents), haemodynamic monitoring, hepato-splanchnic circulation and microcirculatory disorders.

Volume Editors