Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial.
BACKGROUND
Ethics consultations increasingly are being used to resolve conflicts about life-sustaining interventions, but few studies have reported their outcomes.


OBJECTIVE
To investigate whether ethics consultations in the intensive care setting reduce the use of life-sustaining treatments delivered to patients who ultimately did not survive to hospital discharge, as well as the reactions to the consultations of physicians, nurses, and patients/surrogates.


METHODS
Prospective, multicenter, randomized controlled trial from November 2000 to December 2002.


METHODS
Adult intensive care units (ICUs) of 7 US hospitals representing a spectrum of institutional characteristics.


METHODS
Five hundred fifty-one patients in whom value-related treatment conflicts arose during the course of treatment.


METHODS
Patients were randomly assigned either to an intervention (ethics consultation offered) (n = 278) or to usual care (n = 273).


METHODS
The primary outcomes were ICU days and life-sustaining treatments in those patients who did not survive to hospital discharge. We examined the same measures in those who did survive to discharge and also compared the overall mortality rates of the intervention and usual care groups. We also interviewed physicians and nurses and patients/surrogates about their views of the ethics consultation.


RESULTS
The intervention and usual-care groups showed no difference in mortality. However, ethics consultations were associated with reductions in hospital (-2.95 days, P =.01) and ICU (-1.44 days, P =.03) days and life-sustaining treatments (-1.7 days with ventilation, P =.03) in those patients who ultimately did not survive to discharge. The majority (87%) of physicians, nurses, and patients/surrogates agreed that ethics consultations in the ICU were helpful in addressing treatment conflicts.


CONCLUSIONS
Ethics consultations were useful in resolving conflicts that may have inappropriately prolonged nonbeneficial or unwanted treatments in the ICU.
Schneiderman
Lawrence J
LJ
Department of Family and Preventive Medicine, University of California, San Diego, La Jolla 92093, USA. ljs@ucsd.edu
Gilmer
Todd
T
Teetzel
Holly D
HD
Dugan
Daniel O
DO
Blustein
Jeffrey
J
Cranford
Ronald
R
Briggs
Kathleen B
KB
Komatsu
Glen I
GI
Goodman-Crews
Paula
P
Cohn
Felicia
F
Young
Ernlé W D
EW
D000328:Adult; D003422:Critical Care / Q000941:ethics*; D033061:Ethics Consultation; D026690:Ethics, Clinical; D006801:Humans; D007362:Intensive Care Units / Q000941:ethics; D007902:Length of Stay; D018447:Medical Futility; D010347:Patient Care Planning; D010348:Patient Care Team; D011446:Prospective Studies; D014481:United States