Page 159 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

CHAPTER 19: Legal Issues in Critical Care 125

can improve family outcomes and expedite informed decision making CHAPTER Legal Issues in Critical Care
by using specific communication strategies with support from other
specialty clinicians, such as palliative care, spiritual care, and ethics.
Finally, ICU clinicians should work toward integrating key principles 19 Marshall B. Kapp
of palliative care into their ICUs including identification and treatment
of suffering, provision of interdisciplinary care, and offering patient/
family-centered care.
KEY POINTS
• Legal concerns become less dominating and intrusive, and more
KEY REFERENCES likely to be supplanted by ethical considerations, when critical care
• Abbott KH, Sago JG, Breen CM, Abernethy AP, Tulsky JA. teams initiate and continue sensitive, consistent, and honest com-
Families looking back: one year after discussion of withdrawal munication with their patients and significant others.
or withholding of life-sustaining support. Crit Care Med. January • Most informed consent legal cases are framed as negligence
2001;29(1):197-201. actions, in which the alleged unintentional wrong is the physician’s
• Azoulay E, Timsit JF, Sprung CL, et al. Prevalence and factors of violation of the fiduciary or trust duty to serve the patient’s best
intensive care unit conflicts: the conflicus study. Am J Respir Crit interests by informing the patient adequately as part of the testing
Care Med. November 1, 2009;180(9):853-860. and treatment authorization process.
• Clarke EB, Curtis JR, Luce JM, et al. Quality indicators for • In order to be considered legally effective, consent to medical
end-of-life care in the intensive care unit. Crit Care Med. 2003 treatment must (in the absence of a valid exception such as an
Sep;31(9):2255-2262. unforeseeable emergency) be voluntary, informed, and made by a
• Curtis JR, Back AL, Ford DW, et al. Effect of communication skills cognitively and emotionally capable decision maker.
training for residents and nurse practitioners on quality of com- • Consent remains necessary for the treatment of decisionally inca-
munication with patients with serious illness: a randomized trial. pacitated patients, but the consent must be obtained from a sur-
JAMA. 2013;310(21):2271-81. rogate acting on the patient’s behalf.
• Curtis JR, Nielsen EL, Treece PD, et al. Effect of a quality- • A properly informed, mentally capable patient has the right to
improvement intervention on end-of-life care in the intensive care make personal medical decisions, including a decision to refuse
unit: a randomized trial. Am J Respir Crit Care Med. 2011;183: even life-prolonging treatment.
348-355. • A surrogate is expected to make decisions consistent with what the
• Daly BJ, Douglas SL, O’Toole E, et al. Effectiveness trial of an patient would choose if he or she were presently able to make and
intensive communication structure for families of long-stay ICU express choices personally—the substituted judgment standard.
patients. Chest. 2010;138:1340-1348. • The ability of physicians to consult institutional guidelines con-
• Davidson JE, Powers K, Hedayat KM, et al. Clinical practice cerning patient admission to, retention in, and discharge from
guidelines for support of the family in the patient-centered ICUs generally leads to better, more consistent decisions that are
intensive care unit: American College of Critical Care Task Force easier to defend against later claims of impropriety.
2004–2005. Crit Care Med. 2007;35:605-622. • The “brain death” standard provides, as either an alternative to or a
• Hua MS, Li G, Blinderman CD, Wunsch H. Estimates of the need replacement for the traditional heart-lungs approach, that a person is
for palliative care consultation across united states intensive care legally dead when there is irreversible cessation of all brain function.
units using a trigger-based model. Am J Respir Crit Care Med. • Creating and maintaining accurate records of patient care is an inte-
2014;189(4):428-436. gral part of the duty that a health care provider owes to a patient.
• Kross EK, Engelberg RA, Downey L, et al. Differences in end-of-life • Particular areas of attention in a critical care–sensitive risk man-
care in the ICU across patients cared for by medicine, surgery, neu- agement program should include the organization and admin-
rology, and neurosurgery physicians. Chest. 2014;145(2):313-321. istration of ICUs, the roles and responsibilities of the different
• Lanken PN, Terry PB, Delisser HM, et al. An official American professionals having contact with patients in those units, medi-
thoracic society clinical policy statement: palliative care for cal records, equipment maintenance, equipment modification,
patients with respiratory diseases and critical illnesses. Am J Respir equipment records, analysis of equipment malfunctions, incident
Crit Care Med. 2008;177:912-927. reporting, and trend analysis of unexpected incidents.
• Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for
patients with metastatic non–small-cell lung cancer. N Engl J Med.
2010;363:733-742.
• White DB, Evans LR, Bautista CA, Luce JM, Lo B. Are physicians’
recommendations to limit life support beneficial or burdensome? The making, implementation, and documentation of patients’ treatment
Bringing empirical data to the debate. Am J Respir Crit Care Med. decisions in the practice of critical care medicine raise a host of poten-
August 15, 2009;180(4):320-325. tial legal implications. This chapter briefly outlines some of the more
• Yaguchi A, Truog R, Curtis J, et al. International differences in salient issues and suggests avenues for their management and further
end-of-life attitudes in the intensive care unit: results of a survey. exploration.
Arch Intern Med. 2005;165:1970-1975. This chapter concentrates primarily on the chief legal ramifications
of critical care medicine in the United States. It should be recognized,
however, that law is increasingly influencing the delivery of critical care
medicine elsewhere in the world as well. Historically, Non-American
REFERENCES critical care physicians have tended to behave more paternalistically
and unilaterally than their American counterparts, but “the apparently
Complete references available online at www.mhprofessional.com/hall increasing frequency of contentious legal cases in other countries” in the

Section01.indd 125 1/22/2015 9:37:50 AM