Ethical, legal, and communication challenges in managing goals-of-care discussions in chronically critically ill patients

Shahla Siddiqui, Wei Wei Zhang, Katharina Platzbecker, Molly J. Douglas, Laura K. Rock, Matthias Eikermann

Research output: Contribution to journalReview articlepeer-review

Abstract

Clinicians should expect controversial goals of care discussions in the surgical intensive care from time to time. Differing opinions about the likelihood of meaningful recovery in patients with chronic critical illness often exist between intensive care unit providers of different disciplines. Outcome predictions presented by health-care providers are often reflections of their own point of view that is influenced by provider experience, profession, and personal values, rather than the consequence of reliable scientific evaluation. In addition, family members of intensive care unit patients often develop acute cognitive, psychologic, and physical challenges. Providers in the surgical intensive care unit should approach goals-of-care discussions in a structured and interprofessional manner. This best practice paper highlights medical, legal and ethical implications of changing goals of care from prioritizing cure to prioritizing comfort and provides tools that help physicians become effective leaders in the multi-disciplinary management of patients with challenging prognostication.

Original languageEnglish (US)
Pages (from-to)231-237
Number of pages7
JournalJournal of Critical Care
Volume63
DOIs
StatePublished - Jun 2021
Externally publishedYes

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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