On Best Interests: A Case for Clinical Ethics Consultation.
Karen O Moss, Robert Guerin, Olubukunola Mary Dwyer and 2 others
PMID 31804280WHAT IT FOUND
A bedside nurse asked ethics consultation whether daily transfusions and CPR should continue for a dying ICU patient with no advance directive and a surrogate who refused discussion.
The report describes an ethics-consultation process, not tested practice.
Key findings
01A bedside nurse asked the ethics consultation service whether treatment limits on daily transfusions and resuscitation could be imposed without surrogate permission.
02The patient had end-stage liver cirrhosis, bleeding esophageal varices, vasopressor dependence, daily transfusions, no written advance directive, and a named surrogate father who refused to discuss end-of-life care.
03After permission from his mother, bleeding areas were cauterized, then he had cardiopulmonary arrest; CPR was withheld and he died within minutes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
It describes a single patient, so it cannot show how often ethics consultation changes care or improves outcomes. The ethical conclusions are the authors' analysis, not tested results. The patient had no written advance directive and little known about his values, so substituted judgment was uncertain. The father's and mother's roles were inferred from limited visits and conversations. The authors cite a national CPR survival figure from another study; it is not measured in this case. There were no comparison groups, random allocation, or statistical outcome analysis.
Declared interests
The authors declare no conflicts of interest. The article is listed as supported by NIH extramural research.
The easy way to misread this
Do not read this as evidence that ethics consultation or withholding CPR improves outcomes for dying ICU patients. It is a single case report with no comparison group, and the decision depended on this patient's liver failure, bleeding, lack of advance directive, and surrogate situation.