Diana Spoljar1, Marko Curkovic2, Chris Gastmans3, Bert Gordijn4, Dina Vrkic5, Ana Jozepovic6, Suzana Vuletic7, Dinko Tonkovic8, Ana Borovecki9. 1. University Hospital Dubrava, School of Medicine, University of Zagreb, Avenija Gojka Šuška 6, 10000 Zagreb, Croatia. Electronic address: dspoljar@kbd.hr. 2. University Psychiatric Hospital Vrapče, School of Medicine, University of Zagreb, Bolnička Cesta 32, 10000 Zagreb, Croatia. 3. Centre for Biomedical Ethics and Law, Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, Box 7001, 3000 Leuven, Belgium. Electronic address: chris.gastmans@kuleuven.be. 4. Institute of Ethics, School of Theology, Philosophy, and Music, Dublin City University, DCU All Hallows Campus, Dublin 9, Ireland. Electronic address: bert.gordijn@dcu.ie. 5. Central Medical Library, School of Medicine, University of Zagreb, Šalata ul. 2, 10000 Zagreb, Croatia. Electronic address: dina.vrkic@mef.hr. 6. School of Medicine, University of Zagreb, Šalata ul. 2, 10000 Zagreb, Croatia. 7. Catholic Faculty of Theology in Đakovo, University of Josip Juraj Strossmayer in Osijek, Petra Preradovića 17, 31400 Đakovo, Croatia. 8. University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Kišpatićeva ul. 12, 10000 Zagreb, Croatia. 9. Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Johna Davidsona Rockfellera 4, 10000 Zagreb, Croatia.
Abstract
PURPOSE: Intensive care unit health care professionals must be skilled in providing end-of-life care. Crucial in this kind of care is end-of-life decision-making, which is a complex process involving a variety of stakeholders and requiring adequate justification. The aim of this systematic review is to analyse papers tackling ethical issues in relation to end-of-life decision-making in intensive care units. It explores the ethical positions, arguments and principles. METHODS: A literature search was conducted in bibliographic databases and grey literature sources for the time period from 1990 to 2019. The constant comparative method was used for qualitative analysis of included papers in order to identify ethical content including ethical positions, ethical arguments, and ethical principles used in decision-making process. RESULTS: In the 15 included papers we have identified a total of 43 ethical positions. Ten positions were identified as substantive, 33 as procedural. Twelve different ethical principles emerged from the ethical arguments. The most frequently used principles are the principles of beneficence, autonomy and nonmaleficence. CONCLUSIONS: We have demonstrated that recommendations and guidelines designed specifically by intensive or critical care experts for intensive care units promote similar ethical positions, with minimal dissenting positions.
PURPOSE: Intensive care unit health care professionals must be skilled in providing end-of-life care. Crucial in this kind of care is end-of-life decision-making, which is a complex process involving a variety of stakeholders and requiring adequate justification. The aim of this systematic review is to analyse papers tackling ethical issues in relation to end-of-life decision-making in intensive care units. It explores the ethical positions, arguments and principles. METHODS: A literature search was conducted in bibliographic databases and grey literature sources for the time period from 1990 to 2019. The constant comparative method was used for qualitative analysis of included papers in order to identify ethical content including ethical positions, ethical arguments, and ethical principles used in decision-making process. RESULTS: In the 15 included papers we have identified a total of 43 ethical positions. Ten positions were identified as substantive, 33 as procedural. Twelve different ethical principles emerged from the ethical arguments. The most frequently used principles are the principles of beneficence, autonomy and nonmaleficence. CONCLUSIONS: We have demonstrated that recommendations and guidelines designed specifically by intensive or critical care experts for intensive care units promote similar ethical positions, with minimal dissenting positions.