[Analysis of a clinical ethics consultation experience in intensive care].
BACKGROUND
Very few patients are presented to ethics committees, and individual ethics consultations are a response to this situation. At the intensive care unit (ICU) in Clínica Alemana, Santiago Chile, an ethics consultation system was organized coordinated with the ethics committee.


OBJECTIVE
To report an evaluation of this ethics consultation system.


METHODS
Analysis of the first 50 cases analyzed in the consultation system. Analysis of the responses of intensive care physicians to a questionnaire about the main ethical problems that they face in their work.


RESULTS
The consultation system is mainly required by the ICU staff and reports to the ethics committee. Fifty four percent of patients subjected to consultation were aged over 80 years. The main diagnoses were neurological, oncological or cardiopulmonary problems. The ethical problems identified were treatment limitation (62%), proportionality or futility (42%), need of a peaceful death (36%), lack of anticipated decisions (28%), disagreement between physicians and patient's family (24%), undefined subrogation (14%), and abuse of public resources (14%). Twenty six of 31 ICU physicians answered the questionnaire, using a 1 (min) to 7 (max.) scale. They found that consultation is helpful for decision making (6.3), useful for improving ethical perception (6.0), supportive for staff (6.5), good for patients (6.3), supportive for families (6.7), and timely performed (5.2).


CONCLUSIONS
As a complement for the ethics committee's work, consultation is a valid alternative for ethics counselling and a support for physicians and patient's families. Its implementation depends on the particularities of each health institution.
Centro de Bioética, Alemana Universidad del Desarrollo, Santiago de Chile, jpbeca@udd.cl
Juan Pablo
JP
Beca
Alejandro
A
Koppmann
Pamela
P
Chávez
Iris
I
Delgado
Sebastián
S
Solar
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002677:Chile; D003258:Consumer Behavior / Q000706:statistics & numerical data; D003422:Critical Care / Q000941:ethics*; D028741:Ethics Committees, Clinical; D033061:Ethics Consultation / Q000145:classification / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged