title: Ethical Issues in Surgical Critical Care: The Complexity of Interpersonal Relationships in the Surgical Intensive Care Unit.
abstract: A major challenge in the era of shared medical decision making is the navigation of complex relationships between the physicians, patients, and surrogates who guide treatment plans for critically ill patients. This review of ethical issues in adult surgical critical care explores factors influencing interactions among the characters most prominently involved in health care decisions in the surgical intensive care unit: the patient, the surrogate, the surgeon, and the intensivist. Ethical tensions in the surgeon-patient relationship in the elective setting may arise from the preoperative surgical covenant and the development of surgical complications. Unlike that of the surgeon, the intensivist's relationship with the individual patient must be balanced with the need to serve other acutely ill patients. Due to their unique perspectives, surgeons and intensivists may disagree about decisions to pursue life-sustaining therapies for critically ill postoperative patients. Finally, although surrogates are asked to make decisions for patients on the basis of the substituted judgment or best interest standards, these models may underestimate the nuances of postoperative surrogate decision making. Strategies to minimize conflicts regarding treatment decisions are centered on early, honest, and consistent communication between all parties.
authors.affiliation: Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA msur@post.harvard.edu.
authors.forename: Malini D
authors.initials: MD
authors.lastname: Sur
authors.affiliation: Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA Bucksbaum Institute for Clinical Excellence, The University of Chicago Medicine, Chicago, IL, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Angelos
mesh_terms: D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making / Q000941:ethics*; D003142:Communication; D003422:Critical Care / Q000941:ethics*; D016638:Critical Illness / Q000523:psychology / Q000628:therapy*; D005190:Family / Q000523:psychology; D006801:Humans; D007362:Intensive Care Units; D007398:Interpersonal Relations; D010347:Patient Care Planning / Q000941:ethics*; D010817:Physician-Patient Relations / Q000941:ethics*; D013315:Stress, Psychological / Q000523:psychology; D013514:Surgical Procedures, Operative / Q000941:ethics*; D020458:Third-Party Consent / Q000941:ethics
keywords: ethical issues; futility; surgeon–intensivist relationship; surgical critical care; surgical ethics; surgical intensive care unit; surrogate decision making