title: Ethical issues associated with in-hospital emergency from the Medical Emergency Team's perspective: a national survey.
abstract: BACKGROUND
  Medical Emergency Teams (METs) are frequently involved in ethical issues associated to in-hospital emergencies, like decisions about end-of-life care and intensive care unit (ICU) admission. MET involvement offers both advantages and disadvantages, especially when an immediate decision must be made. We performed a survey among Italian intensivists/anesthesiologists evaluating MET's perspective on the most relevant ethical aspects faced in daily practice.
  
  
  METHODS
  A questionnaire was developed on behalf of the Italian scientific society of anesthesia and intensive care (SIAARTI) and administered to its members. Decision making criteria applied by respondents when dealing with ethical aspects, the estimated incidence of conflicts due to ethical issues and the impact on the respondents' emotional and moral distress were explored.
  
  
  RESULTS
  The questionnaire was completed by 327 intensivists/anesthesiologists. Patient life-expectancy, wishes, and the quality of life were the factors most considered for decisions. Conflicts with ward physicians were reported by most respondents; disagreement on appropriateness of ICU admission and family unpreparedness to the imminent patient death were the most frequent reasons. Half of respondents considered that in case of conflicts the final decision should be made by the MET. Conflicts were generally recognized as causing increased and moral distress within the MET members. Few respondents reported that dedicated protocols or training were locally available.
  
  
  CONCLUSIONS
  Italian intensivists/anesthesiologists reported that ethical issues associated with in-hospital emergencies are occurring commonly and are having a significant negative impact on MET well-being. Conflicts with ward physicians happen frequently. They also conveyed that hospitals don't offer ethics training and have no protocols in place to address ethical issues.
authors.affiliation: Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy - cabrini.luca@hsr.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Cabrini
authors.forename: Alberto
authors.initials: A
authors.lastname: Giannini
authors.forename: Margherita
authors.initials: M
authors.lastname: Pintaudi
authors.forename: Federico
authors.initials: F
authors.lastname: Semeraro
authors.forename: Giulio
authors.initials: G
authors.lastname: Radeschi
authors.forename: Sara
authors.initials: S
authors.lastname: Borga
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Herbert
authors.initials: H
authors.lastname: Troiano
authors.forename: Marco
authors.initials: M
authors.lastname: Luchetti
authors.forename: Thomas
authors.initials: T
authors.lastname: Pellis
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ristagno
authors.forename: Giulio
authors.initials: G
authors.lastname: Minoja
authors.forename: Davide
authors.initials: D
authors.lastname: Mazzon
authors.forename: Daniela
authors.initials: D
authors.lastname: Alampi
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000941:ethics* / Q000706:statistics & numerical data; D004992:Ethics, Medical / Q000193:education; D019538:Health Care Surveys; D057209:Hospital Rapid Response Team / Q000941:ethics* / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D011795:Surveys and Questionnaires; D013727:Terminal Care