Purpose
To identify sources of ethical tension emerging around ICU admission decision-making. To assess the potential role for clinical ethics applications in building clinician capacity to identify and navigate these tensions along with an appropriate core principle for framing ethical considerations.
Methods
We performed a search of Ovid Medline, CINAHL and PubMed databases. Keywords and MeSH headings included “intensive care admission”, “decision-making”, “conflict” and “clinical ethics” for the period January 1, 2005 to January 1, 2025. Additional papers were identified from reference lists and formulated into a narrative synthesis of themes describing shared ethical tensions. We then undertook further review of the bioethics literature to identify practical solutions based on clinical ethics consultation and an appropriate normative lens to apply to balancing considerations.
Results
Clinical ethics approaches have been employed to understand sources of ethical tension and improve the process of decision-making around ICU admission. Clinicians' difficulty weighing benefits and burdens of treatments emerged as a potentially modifiable deficit. Proportionality emerged as a more appropriate way than futility or rescue imperatives to frame the value of ICU admission. Uncertainty emerged as an important modifiable contributor to decision-making challenges.
Conclusions
Moral case deliberation as an example of a clinical ethics approach shows promise as an education tool and a way to build decision-making capacity and trust between ICU and other clinicians. Proportionality is a suitable approach to framing benefit and weighing competing tensions. Further research is required to explore the impact of these elements on navigating shared ethical tensions.
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