Clinical ethics consultation in the intensive care unit

The intensive care unit (ICU) represents one of the most ethically burdensome health care settings where uncertainties and disagreements concerning proportionate treatments, goals of care and patients' best interests frequently come up. Clinical ethics consultation (CEC) is a service available to hospital staff, patients and their family members to handle and resolve such moral doubts and conflicts. Considered as the most challenging activity of clinical ethics, it aims to improve the quality of patient care and to increase both health care professionals' familiarity with ethical issues and their competence in identifying and analyzing moral problems. Data concerning CEC in IC Us reveal how it reduces provision of disproportionate treatments, hospital costs and conflicts in addition to producing user satisfaction. First, we show what use CEC can have in an ICU, especially in the process of shared decision making. Then, we analyze two attitudes which may prevent CEC from being fully integrated in the health care system. Lastly, we illustrate the advantages of implementing a clinical ethics service where the full spectrum of ethics support activities are ensured on an ongoing basis.