Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: In their randomized trial, Dr
Schneiderman and colleagues1 reported that
ethics consultation in the intensive care unit (ICU) led to shorter ICU stays
and fewer invasive interventions among patients who apparently would not have
benefitted from them. The authors also reported that 80% of patients and surrogates
expressed satisfaction with the ethics consultation process. As Dr Lo2 pointed out in his Editorial, the authors apparently
excluded non–English-speaking surrogates. I am similarly concerned that
these results may overstate the degree of satisfaction, because surrogates
were identified for interview by the clinicians involved with the case. I
am skeptical that this method for identifying surrogates could have resulted
in a representative range of experience and opinion. In my experience, clinicians
sometimes identify a particular family member as the most receptive or reasonable,
even if that individual is not the identified surrogate or the one most familiar
with the patient's wishes. In cases where there is no appointed surrogate,
the process of families arriving at treatment consensus on behalf of a loved
one can be fractious, with some family members ultimately alienated from the
health care team and the hospital setting. It seems likely that the views
of marginalized family members were underrepresented in this sample.
Quigley R. Ethics Consultation in the Intensive Care Unit—Reply. JAMA. 2003;290(24):3191–3192. doi:10.1001/jama.290.24.3191-a
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