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58 - Critical and intensive care ethics

Published online by Cambridge University Press:  30 October 2009

By
Philip D. Levine  and
Charles L. Sprung
Edited by
Peter A. Singer  and
A. M. Viens
Philip D. Levine
Affiliation:
Attending Physician Department of Anesthesiology and Critical Care Medicine Hadassah Hebrew University Hospital Jerusalem, Israel
Charles L. Sprung
Affiliation:
Professor of Medicine and Critical Care Medicine Hadassah University Hospital Jerusalem, Israel
Peter A. Singer
Affiliation:
University of Toronto
A. M. Viens
Affiliation:
University of Oxford
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Summary

A 70-year-old male patient (Patient E) is admitted to the intensive care unit (ICU) following a road traffic accident in which he suffered severe head and abdominal injuries. After four weeks in the ICU, the patient's neurological condition has stabilized with minimal function (the patient does not communicate but withdraws all four limbs to painful stimuli). Following numerous bouts of sepsis, the patient is developing renal failure. He is anuric, hyperkalemic, and acidotic. He is also ventilator dependent and on high doses of inotropes. The patient's family states that in their culture, life continues until the heart stops beating. The family (that includes a physician) requests that all resuscitative efforts be continued, including dialysis.

In parallel, a second patient (Patient F) with similar injuries, but with metastatic prostate cancer, is admitted to the emergency room and requires an ICU bed. In addition to his traumatic injuries, however, he is wheel-chair bound as a result of dementia. No beds are currently available. According to the assessment of the ICU physician attending, the trauma patient described in case one has the least to benefit from ICU therapy and should be assessed for withdrawal of ventilation, to which the family strenuously objects.

What is critical and intensive care ethics?

Many aspects of medical care practiced today would not be feasible without the support of an intensive care unit (ICU).

Type
Chapter
Information
The Cambridge Textbook of Bioethics , pp. 462 - 468
Publisher: Cambridge University Press
Print publication year: 2008

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  • Critical and intensive care ethics
    • By Philip D. Levine, Attending Physician Department of Anesthesiology and Critical Care Medicine Hadassah Hebrew University Hospital Jerusalem, Israel, Charles L. Sprung, Professor of Medicine and Critical Care Medicine Hadassah University Hospital Jerusalem, Israel
  • Edited by Peter A. Singer, University of Toronto, A. M. Viens, University of Oxford
  • Book: The Cambridge Textbook of Bioethics
  • Online publication: 30 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545566.068
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Critical and intensive care ethics
    • By Philip D. Levine, Attending Physician Department of Anesthesiology and Critical Care Medicine Hadassah Hebrew University Hospital Jerusalem, Israel, Charles L. Sprung, Professor of Medicine and Critical Care Medicine Hadassah University Hospital Jerusalem, Israel
  • Edited by Peter A. Singer, University of Toronto, A. M. Viens, University of Oxford
  • Book: The Cambridge Textbook of Bioethics
  • Online publication: 30 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545566.068
Available formats
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Critical and intensive care ethics
    • By Philip D. Levine, Attending Physician Department of Anesthesiology and Critical Care Medicine Hadassah Hebrew University Hospital Jerusalem, Israel, Charles L. Sprung, Professor of Medicine and Critical Care Medicine Hadassah University Hospital Jerusalem, Israel
  • Edited by Peter A. Singer, University of Toronto, A. M. Viens, University of Oxford
  • Book: The Cambridge Textbook of Bioethics
  • Online publication: 30 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511545566.068
Available formats
×