Ethics

Mission

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.

Board

Position Name City & Country
Chair Andrej Michalsen Germany
Deputy Rik Gerritsen The Netherlands

Working Groups

    All ESICM members interested in this field are very welcome to participate in the activities of our section and join our group. For further information please contact the Chair Andrej Michalsen or the Deputy Chair Rik Gerritsen .

Meetings

Minute

Activities

The section usually meets twice a year, during the annual ESICM congress in the Autumn and during the International Symposium on Intensive Care and Emergency Medicine in Brussels in the Spring.

Besides their involvement in the annual ESICM congresses and other activities of the Society, e.g. the ECCRN and the PACT modules, members of the Ethics Section are actively involved in research in the field of ethics, amongst others the ETHICUS-, ELDICUS-, ETHICATT-, WELPICUS-, CONFLICUS, APPROPRICUS- and the EUROPAIN-Studies.  Members of the section have also been involved in several publications (see below). 


Ongoing Activities

Elie Azoulay and Jozef Kesecioglu represented the society in the ATS project entitled "Statement on futility and goal conflict in end-of-life care in ICUs." Recently, a statement has been drafted and circulated within tenors of ethical issues in the US and Canada. This statement makes reference issues such as the definition of futility, patient-physician relationships, guidelines, end-of-life preferences and the importance of autonomy in this context and the recognition of post-ICU syndrome. Elie and Jozef raised concerns regarding the huge discrepancies all over Europe. Also, some differences in the process of admitting patients to the ICUs were highlighted as ICU refusals occur frequently in Europe but only rarely in North America. The group does not intend to produce a statement that would be valid elsewhere than in North America. Concerns were stated on that point and some revisions were suggested.

At the end of November 2011, the ECCRN Trial Group met in Nice for the third time. Two issues of strategic importance to intensive care practice in Europe and beyond were addressed during the meeting. The first of these was to establish the incidence of and burden from severe acute respiratory infections in the ICU. It was decided to perform an observational study to describe this problem within Europe and beyond. The second question considered was related to the use of SDD in Europe.  In spite of the study data, this approach has not been widely accepted into practice.  Given its potential importance, and the expertise that exists within Europe, it was decided that ESICM TG support an initiative to perform a study in European centres. 



Media:

icTV interview on Strategies to avoid Burnout

icTV interview with Ethics section Chair Jozef Kesecioglu on Redefining the ICU Environment



Publications (by topic)

•  End-of-life care in the ICU

Are religion and religiosity important to end-of-life decisions and patient autonomy in the ICU? The Ethicatt study. Bülow HH, Sprung CL, Baras M, Carmel S, Svantesson M, Benbenishty J, Maia PA, Beishuizen A, Cohen S, Nalos D. Intensive Care Med. 2012; 38:1126-33.

Attitudes of European physicians, patients, nurses, and families regarding end-of-life decisions: the ETHICATT study. Sprung CL, Carmel S, Sjokvist P, Baras M, Cohen SL, Maia P, Beishuizen A, Nalos D, Novak I, Svantesson M, Benbenishty J, Henderson B; ETHICATT Study Group. Intensive Care Med. 2007; 104-10.

End-of-life practices in European intensive care units: the Ethicus Study. Sprung CL, Cohen SL, Sjokvist P, Baras M, Bulow HH, Hovilehto S, Ledoux D, Lippert A, Maia P, Phelan D, Schobersberger W, Wennberg E, Woodcock T; Ethicus Study Group. JAMA. 2003;290:790-7

•  Conflicts in the ICU

Conflicts and communication gaps in the intensive care unit. Fassier T, Azoulay E. Curr Opin Crit Care. 2010 Oct 7.

Prevalence and factors of intensive care unit conflicts: the conflicus study. Azoulay E, Timsit JF, Sprung CL, Soares M, Rusinová K, Lafabrie A, Abizanda R, Svantesson M, Rubulotta F, Ricou B, Benoit D, Heyland D, Joynt G, Français A, Azeivedo-Maia P, Owczuk R, Benbenishty J, de Vita M, Valentin A, Ksomos A, Cohen S, Kompan L, Ho K, Abroug F, Kaarlola A, Gerlach H, Kyprianou T, Michalsen A, Chevret S, Schlemmer B; Conflicus Study Investigators and for the Ethics Section of the European Society of Intensive Care Medicine. Am J Respir Crit Care Med 2009; 180:853-60.

• Admission To ICU and Extent of treatment

The Eldicus prospective observational study of triage decision-making in European intensive care units. Part II: intensive care benefit for the elderly. Sprung CL, Artigas A, Kesecioglu J, Pezzi A, Wiis J, Pirracchio R, Baras M, Edbrooke DL, Pesenti A, Bakker J, Hargreaves C, Gurman G, Cohen SL, Lippert A, Payen D, Corbella D, Iapichino G. Crit Care Med. 2012 ; 40:132-8.

The Eldicus prospective observational study of triage decision-making in European intensive care units: Part I - European Intensive Care Admission Triage Scores. Sprung CL, Baras M, Iapichino G, Kesecioglu J, Lippert A, Hargreaves C, Pezzi A, Pirracchio R, Edbrooke DL, Pesenti A, Bakker J, Gurman G, Cohen SL, Wiis J, Payen D, Artigas A. Crit Care Med. 2012; 40:125-31.

Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. Piers RD, Azoulay E, Ricou B, Dekeyser Ganz F, Decruyenaere J, Max A, Michalsen A, Maia PA, Owczuk R, Rubulotta F, Depuydt P, Meert AP, Reyners AK, Aquilina A, Bekaert M, Van den Noortgate NJ, Schrauwen WJ, Benoit DD; APPROPRICUS Study Group of the Ethics Section of the ESICM. JAMA 2011; 306:2694-703.

•  Burnout in the ICU

Burnout syndrome among critical care workers. Le Gall JR, Azoulay E, Embriaco N, Poncet MC, Pochard F. Bull Acad Natl Med. 2011;195:389-97.

Burnout in ICU caregivers: a multicenter study of factors associated to centers. Merlani P, Verdon M, Businger A, Domenighetti G, Pargger H, Ricou B; STRESI+ Group. Am J Respir Crit Care Med 2011; 184:1140-6.

Burnout in anesthesia and intensive care medicine. Part 2: epidemiology and importance for the quality of care. Michalsen A, Hillert A. Anaesthesist 2011; 60:31-8.

Burnout in anesthesia and intensive care medicine. Part 1: Clarification and critical evaluation of the term.  Michalsen A, Hillert A. Anaesthesist 2011; 60:23-30.

Burnout syndrome among critical care health care workers. Embriaco N, Papazian L, Kentish-Barnes N, Pochard F, Azoulay E. Curr Opin Crit Care 2007; 13:482-8.



Publications (listed by study)

• The ETHICUS-Study

End-of-life practices in European intensive care units: the Ethicus study. Sprung CL, Cohen SL, Sjokvist P et al. JAMA 2003; 290:790-797.

Communication of end-of-life decisions in European intensive care unitsCohen S, Sprung CL, Sjokvist P et al. Intensive Care Med 2005 31:1215–1221

The importance of religious affiliation and culture on end-of-life decisions in European intensive care units. Sprung CL, Maia P, Bulow HH et al.  Intensive Care Med 2007; 33:1732-1739.

Reasons, considerations, difficulties and documentations of end-of-life decisions in European intensive care units: the Ethicus study. Sprung CL, Woodcock T, Sjokvist P et al. Intensive Care Med 2008; 34:271-277. 

• The ETHICATT-Study

Attitudes of European physicians, nurses, patients, and families regarding end-of-life decisions: the Ethicatt studySprung CL, Carmel S, Sjokvist P et al. Intensive Care Med 2007; 33:104-110.

Are religion and religiosity important to end-of-life decisions and patient autonomy in the ICU? The Ethicatt study. Bülow HH, Sprung CL, Baras M et al. Intensive Care Med 2012; 38:1126-33.

• The CONFLICUS-Study

Prevalence and factors of intensive care unit conflicts: the Conflicus study. Azoulay E, Timsit JF, Sprung CL et al. Am J Respir Crit Care Med 2009; 180:853-860.

• The ELDICUS-Study

Reasons for refusal of admissions to intensive care and impact on mortality. Iapichino G, Corbella D, Minelli C et al. Intensive Care Med 2010; 36:1772-1779. 

Implications of ICU triage decisions on patient mortality: a cost effectiveness analysis. Edbrooke DL, Minelli C, Mills GH et al.Crit Care 2011; 15:R56.

The Eldicus prospective, observational study of triage decision making in European intensive care units: part I--European Intensive Care Admission Triage ScoresSprung CL, Baras M, Iapichino G et al. Crit Care Med. 2012; 40:125-31.

The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: intensive care benefit for the elderlySprung CL, Artigas A, Kesecioglu J et al. Crit Care Med. 2012; 40:132-8.

 The APPROPRICUS-Study

Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physiciansPiers RD, Azoulay E, Ricou B et al. JAMA. 2011 28; 306:2694-703.

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