Surrogate Consent for Genomics Research in Intensive Care

2009 ◽  
Vol 18 (5) ◽  
pp. 418-426 ◽  
Author(s):  
Ann K. Shelton ◽  
Anne F. Fish ◽  
J. Perren Cobb ◽  
Jean A. Bachman ◽  
Ruth L. Jenkins ◽  
...  
Keyword(s):  
Intensive Care ◽  
Informed Consent ◽  
Health Care Professionals ◽  
Decision Makers ◽  
Major Theme ◽  
Intensive Care Patients ◽  
Genomics Research ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Surrogate decision makers may be poorly prepared to give informed consent for genomics research for their loved ones in intensive care. A review of the challenges and strategies associated with obtaining surrogates’ consent for genomics research in intensive care patients revealed that few well-controlled studies have been done on this topic. Yet, a major theme in the literature is the role of health care professionals in guiding surrogates through the informed consent process rather than simply witnessing a signature. Informed consent requires explicit strategies to approach potential surrogates effectively, educate them, and ensure that informed consent has been attained.

scholarly journals Protocol and Fidelity Monitoring Plan for Four Supports. A Multicenter Trial of an Intervention to Support Surrogate Decision Makers in Intensive Care Units

2018 ◽  
Vol 15 (9) ◽  
pp. 1083-1091 ◽  
Author(s):  
Jennifer B. Seaman ◽  
Robert M. Arnold ◽  
Praewpannarai Buddadhumaruk ◽  
Anne-Marie Shields ◽  
Rachel M. Gustafson ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Multicenter Trial ◽  
Decision Makers ◽  
Monitoring Plan ◽  
Fidelity Monitoring ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

“Taking over somebody's life”: Experiences of surrogate decision-makers in the surgical intensive care unit

Surgery ◽  
2017 ◽  
Vol 162 (2) ◽  
pp. 453-460 ◽  
Author(s):  
Elizabeth J. Lilley ◽  
Megan A. Morris ◽  
Nicholas Sadovnikoff ◽  
Jamahal M. Luxford ◽  
Navin R. Changoor ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Life Experiences ◽  
Decision Makers ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Taking Over Somebody’s Life: Experiences of Surrogate Decision-Makers in the Surgical Intensive Care Unit

2016 ◽  
Vol 223 (4) ◽  
pp. S48
Author(s):  
Elizabeth J. Lilley ◽  
Megan A. Morris ◽  
Jamahal M.H. Luxford ◽  
Navin R. Changoor ◽  
Anna E. Bystricky ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Life Experiences ◽  
Decision Makers ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Ethics in Pediatric Anesthesiology

2018 ◽  
Author(s):  
Monica Shah ◽  
David Waisel
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Ethics Committees ◽  
Decision Makers ◽  
Best Interest ◽  
Medical Decisions ◽  
Risks And Benefits ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Life Therapy

Ethical principles affect daily decision-making in pediatric anesthesiology. These medical decisions are interlaced with the ethical components of informed consent and obligations to the child and family. Informed consent in pediatrics includes the concepts of best interest, in which the parents or other surrogate decision-makers choose acceptable treatment for the child, and assent, which enables children to participate in decision-making to the best of their ability. Of equal significance to informed consent, the process of informed refusal requires anesthesiologists to more fully inform children and their guardians about risks and benefits while respecting refusal of assent and avoiding coercion. Pediatric considerations regarding end-of-life therapy are slightly different than adult considerations. To help resolve these ethical dilemmas, ethics committees are available for consultations to assist the medical team, family members, and patients in order to make the best decision for the child.

Clinician Ethical Perspectives on Extracorporeal Membrane Oxygenation in Practice

2021 ◽  
pp. 104990912110410
Author(s):  
Gina M. Piscitello ◽  
Rene S. Bermea ◽  
John W. Stokes ◽  
Whitney D. Gannon ◽  
Anthony J. Kanelidis ◽  
...  
Keyword(s):  
Informed Consent ◽  
Extracorporeal Membrane Oxygenation ◽  
Decision Makers ◽  
Ethical Challenge ◽  
Cross Sectional Survey ◽  
Exclusion Criteria ◽  
Cross Sectional ◽  
Membrane Oxygenation ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Purpose: Extracorporeal membrane oxygenation (ECMO) is an expensive and scarce life sustaining treatment provided to certain critically ill patients. Little is known about the informed consent process for ECMO or clinician viewpoints on ethical complexities related to ECMO in practice. Methods: We sent a cross-sectional survey to all departments providing ECMO within 7 United States hospitals in January 2021. One clinician from each department completed the 42-item survey representing their department. Results: Fourteen departments within 7 hospitals responded (response rate 78%, N = 14/18). The mean time spent consenting patients or surrogate decision-makers for ECMO varied, from 7.5 minutes (95% CI 5-10) for unstable patients to 20 minutes (95% CI 15-30) for stable patients (p = 0.0001). Few clinician respondents (29%) report patients or surrogate decision-makers always possess informed consent for ECMO. Most departments (92%) have absolute exclusion criteria for ECMO such as older age (43%, cutoffs ranging from 60-75 years), active malignancy (36%), and elevated body mass index (29%). A significant minority of departments (29%) do not always offer the option to withdraw ECMO to patients or surrogate decision-makers. For patients who cannot be liberated from ECMO and are ineligible for heart or lung transplant, 36% of departments would recommend the patient be removed from ECMO and 64% would continue ECMO support. Conclusion: Adequate informed consent for ECMO is a major ethical challenge, and the content of these discussions varies. Use of categorical exclusion criteria and withdrawal of ECMO if a patient cannot be liberated from it differ among departments and institutions.

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