title: Ethical implications of standardization of ICU care with computerized protocols.
abstract: Ethical issues related to the use of computerized protocols to control mechanical ventilation of patients with Acute Respiratory Distress Syndrome (ARDS) are identical to the ethical issues surrounding the use of any therapy or intervention. Four ethical principles must be considered: nonmaleficence, beneficence, autonomy, and distributed justice. The major ethical challenges to computerized protocol use as a specific application of clinical decision support tools are found within the principles of nonmaleficence and of beneficence. The absence of credible outcome data on which ARDS patient survival probabilities with different therapeutic options could be based is a constraint common to most ICU clinical decision making. Clinicians are thus deprived of the knowledge necessary to define benefit and are limited to beneficent intention in clinical decisions. Computerized protocol controlled decision making for the clinical management of mechanical ventilation for ARDS patients is ethically defensible. It is as well supported as most ICU therapy options.
authors.affiliation: Pulmonary Division, LDS Hospital, Salt Lake City, Utah 84143.
authors.forename: A H
authors.initials: AH
authors.lastname: Morris
authors.forename: T D
authors.initials: TD
authors.lastname: East
authors.forename: C J
authors.initials: CJ
authors.lastname: Wallace
authors.forename: J
authors.initials: J
authors.lastname: Orme
authors.forename: T
authors.initials: T
authors.lastname: Clemmer
authors.forename: L
authors.initials: L
authors.lastname: Weaver
authors.forename: F
authors.initials: F
authors.lastname: Thomas
authors.forename: N
authors.initials: N
authors.lastname: Dean
authors.forename: J
authors.initials: J
authors.lastname: Pearl
authors.forename: B
authors.initials: B
authors.lastname: Rasmusson
mesh_terms: D002985:Clinical Protocols / Q000592:standards; D002986:Clinical Trials as Topic; D003422:Critical Care / Q000592:standards*; D003658:Decision Making, Computer-Assisted; D004992:Ethics, Medical; D006801:Humans; D012128:Respiratory Distress Syndrome / Q000628:therapy