Priority setting in intensive care from an ethical perspective
Priority setting in intensive care is particularly difficult. Physicians must weigh different patient needs, act urgently, and often face uncertainty about the prognosis. Difficult priority decisions in combination with ambiguities in the ethical platform and guidelines risk causing moral stress among the intensive care staff.
Niklas Juth is a professor in medical ethics and research leader at the Centre for Research Ethics & Bioethics at Uppsala University. Together with Eva Hannerz Schmidtke, specialist physician in anesthesia and intensive care and deputy chief physician at Uppsala University Hospital, Niklas Juth recently highlighted the ethical perspective on priority setting in intensive care in the journal Läkartidningen.
Priority setting in Swedish health care is regulated by law in the so-called ethical platform, based on three principles: equal human dignity, need and solidarity, and cost-effectiveness.
In intensive care, there are situations where the degree of severity is maximal for more than one patient at the same time. Several patients may be in a situation where they are at risk of dying if they do not receive maximal interventions immediately. Then, treatment effect and cost-effectiveness become more decisive for prioritization decisions.
The authors are raising questions regarding how the ethical platform should be interpreted. For instance, in intensive care there are patients with a multitude of different conditions, creating situations where comparison is very difficult. According to Niklas Juth and Eva Hannerz Schmidtke, there is a lack of clear ethical guidelines for priority setting in the various situations that arise in intensive care. The combination of ambiguous guidelines and difficult priority decisions risk is causing moral stress among intensive care professionals.
Read the full news article (in Swedish)
By Fanny Klingvall