Basic Principles of Critical Care

1. ETHICAL ASPECTS OF ICU CARE
Gradian Health Systems
Basic Principles of Critical Care
ETHICAL AND LEGAL
DIMENSIONS OF CARE

2. Disclaimer
Basic Principles of Critical Care Training I Ethical Aspects of ICU Care
Disclaimer: Gradian Health Systems cannot provide formal recommendations or indications
regarding medical care and clinical service delivery. The tables, checklists, and other clinical
documents referenced in this training have not been validated in all settings. These documents are
intended to serve as examples only. We recognize that all clinical training content and activities
must be customized to meet the needs of each facility and its clinical staff, factoring in available
resources, practitioner skill level, and other environmental considerations.
For any questions regarding the contents or applications of this training,
please contact Gradian Health Systems:
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3. Module 7
Gradian Health Systems
Basics Principles of Critical Care
Ethical and Legal Dimensions of Care

4. Module 7: Ethical and Legal Dimensions of Care
MODULE OVERVIEW
Lesson 1 I Ethical Aspects of ICU Care
Lesson 2 I Legal Aspects of ICU Care
Basic Principles of Critical Care Training I Ethical Aspects of ICU Care

5. Components of the Gradian CCV SystemLesson 1: Ethical Aspects of ICU Care
Lesson Objectives
• Define ethical terms used in patient care
• Discuss ethical decisions made in ICU
Basic Principles of Critical Care Training I Ethical Aspects of ICU Care

6. Components of the Gradian CCV SystemLesson 1: Ethical Aspects of ICU Care
Key Concepts
• Ethics terminology
• CPR
• Withholding treatment
• Withdrawing treatment
Basic Principles of Critical Care Training I Ethical Aspects of ICU Care

7. Components of the Gradian CCV SystemEthical Aspects of ICU Care
Ethical Principles and Definitions
• Autonomy I patient’s right to self determination
• Beneficence I promoting good
• Nonmaleficence I do no harm
• Veracity I the obligation to tell the truth
• Fidelity I faithfulness to agreement and responsibilities
• Justice I fair allocation of medical resources
Basic Principles of Critical Care Training I Ethical Aspects of ICU Care

8. Components of the Gradian CCV SystemEthical Aspects of ICU Care
Ethical Decisions
• CPR
• Withholding and withdrawing treatment
• End of life
Basic Principles of Critical Care Training I Ethical Aspects of ICU Care

9. Components of the Gradian CCV SystemEthical Aspects of ICU Care
CPR
• A generally accepted position is that resuscitation should cease if the
physician determines the effort to be futile.
• May be stopped when 30 minutes of advanced life support have been
attempted without restoration of HR and breathing
NB: Kenya does not have a law on Advance Directives, and where practiced, it is
usually under institutional policy. At the AKUH, the policy on end of life care was
enacted in 2012.
Ref: Factors that influence advance directives completion amongst terminally ill patients at a tertiary hospital in Kenya.Omondi et al. BMC Palliative Care (2017) 16:9
Basic Principles of Critical Care Training I Ethical Aspects of ICU Care

10. Components of the Gradian CCV SystemEthical Aspects of ICU Care
Withholding or Withdrawal of Life Support
• Withholding I never initiating a treatment
• Withdrawing I to stop a treatment once started
• Withdrawal of life support is indicated if the patient has Glasgow coma scale <
5; absence of motor response 3 days after arrest
• Decisions are best made after careful discussions with healthcare providers
and patient’s family
Basic Principles of Critical Care Training I Ethical Aspects of ICU Care

11. Components of the Gradian CCV SystemEthical Aspects of ICU Care
Resolving Ethical Problems in an ICU Setting
• Gather relevant facts and identify the decision maker(s) and all stakeholder(s)
• Identify the ethical problem(s)
• Analyze problem(s) using ethical guidelines and resources
• Deliberate alternative actions
• Choose one and justify
• Evaluate and reflect
Basic Principles of Critical Care Training I Ethical Aspects of ICU Care