[Ethics conflicts in the application of mechanical ventilation: analysis of the attitude of critical care and emergency professionals and students].
OBJECTIVE
To analyze the influence of prognosis, life quality or previous instructions in the decision making of applying an invasive (intubation/mechanical ventilation), conservative or palliative procedure.


METHODS
"Casuistry" methodology: opinion on the appropriate decision regarding five clinical histories representative of ethic conflicts with 542 health professionals (220 intensive care specialist, 150 emergency department professionals, 76 nurses, and 96 students). As control group, 26 students enrolled in a International Master on Bioethics.


RESULTS
A great inter-group variability was observed (p = 0.005) with a higher agreement with control group between students and lower with intensivists. The agreement observed was highest in cases with "total support" as the appropriate option (kappa 0.85, 0.69, and 0.66) than in cases with "palliative measures" as appropriate option (kappa 0.22 and 0.46).


CONCLUSIONS
1) A high variability was observed regarding decisions on instituting respiratory support. 2) Decisions regarding the restriction of therapeutic efforts are not accepted in the main, even in scenarios merging into futility, as permanent vegetative status. 3) Among severely deteriorated and handicapped patients, perceived life quality is more appreciated by the patient than that estimated objectively. 4) There is no a consensus opinion for the respect of previous guidelines of vital support refusal. 5) Age and deep psychic deficiency are not considered as cause of discrimination. These features may be considered typical of the mediterranean ethics, in which paternalism and charity are more appreciated values than autonomy.
Gómez Rubí
J A
JA
Servicio de Medicina Intensiva, Hospital Universitario Virgen de la Arrixaca, 30120 El Palmar, Murcia. jagrubi@arrixaca.huva.es
Gómez Company
J A
JA
Sanmartín Monzó
J L
JL
Martínez Fresneda
M
M
D001291:Attitude of Health Personnel; D003422:Critical Care; D004636:Emergency Service, Hospital; D004992:Ethics, Medical; D006801:Humans; D012121:Respiration, Artificial; D013030:Spain; D013337:Students, Medical