Context Ethics consultations increasingly are being used to resolve conflicts
about life-sustaining interventions, but few studies have reported their outcomes.
Objective To investigate whether ethics consultations in the intensive care setting
reduce the use of life-sustaining treatments delivered to patients who ultimately
did not survive to hospital discharge, as well as the reactions to the consultations
of physicians, nurses, and patients/surrogates.
Design Prospective, multicenter, randomized controlled trial from November
2000 to December 2002.
Setting Adult intensive care units (ICUs) of 7 US hospitals representing a spectrum
of institutional characteristics.
Patients Five hundred fifty-one patients in whom value-related treatment conflicts
arose during the course of treatment.
Interventions Patients were randomly assigned either to an intervention (ethics consultation
offered) (n = 278) or to usual care (n = 273).
Main Outcome Measures The primary outcomes were ICU days and life-sustaining treatments in
those patients who did not survive to hospital discharge. We examined the
same measures in those who did survive to discharge and also compared the
overall mortality rates of the intervention and usual care groups. We also
interviewed physicians and nurses and patients/surrogates about their views
of the ethics consultation.
Results The intervention and usual-care groups showed no difference in mortality.
However, ethics consultations were associated with reductions in hospital
(−2.95 days, P = .01) and ICU (−1.44
days, P = .03) days and life-sustaining treatments
(−1.7 days with ventilation, P = .03) in those
patients who ultimately did not survive to discharge. The majority (87%) of
physicians, nurses, and patients/surrogates agreed that ethics consultations
in the ICU were helpful in addressing treatment conflicts.
Conclusion Ethics consultations were useful in resolving conflicts that may have
inappropriately prolonged nonbeneficial or unwanted treatments in the ICU.