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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2016 Gennaio;82(1):50-7
Ethical issues associated with in-hospital emergency from the Medical Emergency Team’s perspective: a national survey
Luca CABRINI 1, Alberto GIANNINI 2, Margherita PINTAUDI 1, Federico SEMERARO 3, Giulio RADESCHI 4, Sara BORGA 4, Giovanni LANDONI 1, Herbert TROIANO 5, Marco LUCHETTI 6, Thomas PELLIS 7, Giuseppe RISTAGNO 8, Giulio MINOJA 9, Davide MAZZON 10, Daniela ALAMPI on behalf of the Emergency and of the Bioethics Task Forces of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) ✉
1 Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy; 2 Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy; 3 Anesthesia and Intensive Care Department, Maggiore Hospital, Bologna, Italy; 4 Anesthesia and Intensive Care Unit, San Luigi Hospital, Orbassano, Turin, Italy; 5 Department of Perioperative Medicine, in-hospital Emergency and Intensive Care, SS. Annunziata Hospital, Chieti, Italy; 6 Anesthesia and Intensive Care Unit, A. Manzoni Hospital, Lecco, Italy; 7 Anesthesia and Intensive Care Unit AAS 5, Ospedale Santa Maria degli Angeli, Pordenone, Italy; 8 IRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy; 9 Anesthesia and Intensive Care Unit B, Azienda Ospedale di Circolo e Fondazione Macchi, Varese, Italy; 10 Anesthesia and Intensive Care, Ospedale San Martino, Belluno, Italy; 11 Dipartimento di Scienze Medico-Chirurgiche e di Medicina Traslazionale, Sant’Andrea Hospital, “La Sapienza” University, Rome, Italy
BACKGROUND: Medical Emergency Teams (METs) are frequently involved in ethical issues associated to in-hospital emergencies, like decisions about end-of-life care and intensive care unit (ICU) admission. MET involvement offers both advantages and disadvantages, especially when an immediate decision must be made. We performed a survey among Italian intensivists/anesthesiologists evaluating MET’s perspective on the most relevant ethical aspects faced in daily practice.
METHODS: A questionnaire was developed on behalf of the Italian scientific society of anesthesia and intensive care (SIAARTI) and administered to its members. Decision making criteria applied by respondents when dealing with ethical aspects, the estimated incidence of conflicts due to ethical issues and the impact on the respondents’ emotional and moral distress were explored.
RESULTS: The questionnaire was completed by 327 intensivists/anesthesiologists. Patient life-expectancy, wishes, and the quality of life were the factors most considered for decisions. Conflicts with ward physicians were reported by most respondents; disagreement on appropriateness of ICU admission and family unpreparedness to the imminent patient death were the most frequent reasons. Half of respondents considered that in case of conflicts the final decision should be made by the MET. Conflicts were generally recognized as causing increased and moral distress within the MET members. Few respondents reported that dedicated protocols or training were locally available.
CONCLUSION: Italian intensivists/anesthesiologists reported that ethical issues associated with in-hospital emergencies are occurring commonly and are having a significant negative impact on MET well-being. Conflicts with ward physicians happen frequently. They also conveyed that hospitals don’t offer ethics training and have no protocols in place to address ethical issues.