Ethics (ETH)
Goal of the section
The goal of the Section on Ethics is to help medical personnel that work in intensive care medicine throughout Europe to address ethical issues and thus foster the well-being of the patients in intensive care, their families, and the health care workers themselves. We do so by talking part in educational activities as well as by promoting and performing research in ethics. We specifically take part in scientific activities endorsed by the Society.
Chair and deputy
Chair: Jozef Kesecioglu - Utrecht, The Netherlands
Deputy: Andrej Michalsen - Tuttlingen, Germany
The former chairman of the Section on Ethics were Charles Sprung - Jerusalem, Israel (1889-2001 and 2004-2007), Peter Sjokvist - Stockholm, Sweden (2001-2003), and Elie Azoulay - Paris, France (2007-2010).
Membership
There are currently approximately 50 voting members and roughly 700 registered members. Please note that only the voting members of the Section may elect the chair and the deputy.
Do you wish to be one of the members of this Section or do you wish to change your Section registration? Please go to the "My data" page and update your sections.
Recent and current activities
Studies
In recent years, several European multi-centre studies on ethical issues have been or are being performed with considerable and often pivotal contributions from members of the Section on Ethics, a selection of which is introduced below (including key publications).
1. The ETHICUS-Study
In an observational study amongst over 30,000 patients in 37 ICUs in 17 European countries, approximately 4,000 patients had a limitation of life-sustaining therapy. Substantial variability was found in the limitations and the manner of dying. Limitation of therapy vs. continuation of life-sustaining therapy was associated with patient age, acute and chronic diagnoses, number of days in the ICU, region and religion.
Sprung CL, Cohen SL, Sjokvist P et al. End-of-life practices in European intensive care units: the Ethicus study. JAMA 2003; 290:790-797.
Sprung CL, Maia P, Bulow HH et al. The importance of religious affiliation and culture on end-of-life decisions in European intensive care units. Intensive Care Med 2007; 33:1732-1739.
Sprung CL, Woodcock T, Sjokvist P et al. Reasons, considerations, difficulties and documentations of end-of-life decisions in European intensive care units: the Ethicus study. Intensive Care Med 2008; 34:271-277.
2. The ETHICATT-Study
In a survey amongst roughly 4,400 individuals in Europe - former ICU patients, their family members, ICU physicians and ICU nurses -, the participants’ attitudes regarding quality and meaning of life, ICU treatments, active euthanasia, and place of treatment were elicited. In a first publication it was shown that quality of life was more important for physicians and nurses than patients and families: more medical professionals want fewer ICU treatments and prefer being home or in a hospice for a terminal illness compared to patients and families.
Sprung CL, Carmel S, Sjokvist P et al. Attitudes of European physicians, nurses, patients, and families regarding end-of-life decisions: the Ethicatt study. Intensive Care Med 2007; 33:104.110.
3. The CONFLICUS-Study
In a cross-sectional survey amongst roughly 7,500 health care workers in 323 ICUs in 24 countries, over 70% of the participants reported perceived conflicts, often considered severe and increasing their job strain. Workload, inadequate communication, and end-of-life care were shown to be important targets for improvement.
Azoulay E, Timsit JF, Sprung CL et al. Prevalence and factors of intensive care unit conflicts: the Conflicus study. Am J Respir Crit Care Med 2009; 180:853-860.
4. The ELDICUS-Study
In a multicenter cohort study on approximately 8,600 triages in 11 university hospitals in seven countries, triage decisions and their consequences for the elderly were examined. The authors conclude that intensive care physicians took great care to avoid ICU admissions of patients judged not severely ill enough for ICU or with low performance status. Admission to an ICU was associated with a reduction of both 28- and 90-day mortality. Intensive care appears to be similarly cost-effective as other therapies generally regarded as essential.
Iapichino G, Corbella D, Minelli C et al. Reasons for refusal of admissions to intensive care and impact on mortality. Intensive Care Med 2010; 36:1772-1779.
Edbrooke DL, Minelli C, Mills GH et al. Implications of ICU triage decisions on patient mortality: a cost effectiveness analysis. Crit Care 2011; 15:R56.
5. The APPROPRICUS-Study
In an observational study amongst almost 1,700 health care workers in 82 ICUs in 10 countries, participants were asked to report on perceived inappropriate care rendered to their patients.
The data are still being analyzed. Results are expected to be published in 2011.
Study Proposals
An intervention study, “Self-awareness and individual development in ICU (SAID)”, on the effectiveness of a specific model to improve working conditions and communication among physicians and nurses in intensive care units, was proposed recently by Francesca Rubulotta and will be discussed during the next section meeting in Brussels (see below).
Study Proposals
An intervention study, “Self-awareness and individual development in ICU (SAID)”, on the effectiveness of a specific model to improve working conditions and communication among physicians and nurses in intensive care units, was proposed recently by Francesca Rubulotta and will be discussed during the next section meeting in Brussels (see below).
Meetings agenda and minutes
The minutes of the meeting held in Barcelona on 12 October 2010 are available here.
The minutes of the meeting held in Brussels at the ISICEM on 24 March 2011 are available here.
The minutes of the meeting held in Berlin on 4 October 2011 are available here.
The next section meeting will be held during the 32nd ISICEM in Brussels.
Useful links
ECCRN: see the Society’s web site
EUROPAIN®, an ongoing study on procedural pain in ICUs, funded by the Established Investigator Award, ESICM, 2009: ariane.lafabrie@sls.aphp.fr .
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