Seeking to reduce nonbeneficial treatment in the ICU: an exploratory trial of proactive ethics intervention*.

Objective: To investigate whether the proactive intervention of a clinical ethicist in cases of prolonged lengths of stay in a critical care setting reduces nonbeneficial treatment while increasing perceived patient/surrogate and provider satisfaction and reducing associated costs. Nonbeneficial treatment is defined here as the use of life-sustaining treatments delivered to patients who had been in the ICU for 5 days and did not survive to discharge.

Design: Prospective randomized exploratory trial from October 2007 to February 2010 in the adult ICU of a large, urban, not-for-profit community hospital.

The clinical ethics consultant: verifying the qualifications of a new type of practitioner in a community hospital.

Ethics consultation has been occurring in various forms within hospitals for more than 30 years. These consultations constitute a clinical act, and as such, the qualifications of those who provide them must be verified by the hospitals at which the ethics consultants practice. The clinical nature of the practice exposes the participants to malpractice liability.

Optimising the documentation practices of an Ethics Consultation Service.

A formal Ethics Consultation Service (ECS) can provide significant help to patients, families and hospital staff. As with any other form of clinical consultation, documentation of the process and the advice rendered is very important. Upon review of the published consult documentation practices of other ECSs, we judged that none of them were sufficiently detailed or structured to meet the needs and purposes of a clinical ethics consultation.

Development of a hospital ethics committee: lessons from five years of case consultations.

The development and consultation experience of an ethics committee in an urban community hospital has been presented, and various approaches to case consultation have been considered. Our committee has concentrated on the clinical evaluation model. As expected, most consultations have centered on issues of withdrawing or limiting medical care.

MR imaging of an intrapericardial pheochromocytoma.

The magnetic resonance (MR) appearance of an intrapericardial pheochromocytoma is reported, and the role of MR, compared with CT and a 131I-metaiodobenzylguanidine scan in delineating masses from cardiac and vascular structures in the mediastinum is discussed.