title: Environments that support ethical practice.
abstract: Our healthcare system is fundamentally flawed in the ability to provide quality end-of-life care. The provision of quality end-of-life care involves a complex interaction of personal, professional, and societal values and practices. Attention to each dimension of end-of-life care is essential to improve the care of the dying patient and his/her family. Given the complexity of this problem, this article focuses on the critical care environment and the aspect of organizational culture and specific strategies for improvement. Several inter-related components of an environment which may foster ethical thinking, decision-making, and behaviors are discussed including organizational culture, individual agency, collaboration, and educational resources. Every member of the healthcare team has the responsibility to be a catalyst for creating a critical care environment where ethical practice is expected and rewarded rather than punished and suppressed. As a healthcare team, our ultimate goal is to provide healing and humane end-of-life care for all patients and families.
authors.affiliation: Johns Hopkins University and Children's Center, Baltimore, MD, USA.
authors.forename: C H
authors.initials: CH
authors.lastname: Rushton
authors.forename: J A
authors.initials: JA
authors.lastname: Brooks-Brunn
mesh_terms: D003299:Cooperative Behavior; D003659:Decision Making, Organizational; D004992:Ethics, Medical; D005190:Family / Q000523:psychology; D006272:Health Facility Environment; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D015279:Organizational Culture; D010348:Patient Care Team; D011787:Quality of Health Care; D013727:Terminal Care / Q000592:standards*; D014481:United States