Best practice & research. Clinical anaesthesiology
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Intensive Care Medicine epitomises the difficulties inherent in modern medicine. In this chapter we examine some key medicolegal and ethical areas that are evolving. The principles of autonomy and consent are well established, but developments in UK caselaw have shown that the courts may be moving away from their traditional deference of the medical profession. We examine some recent cases and discuss the impact that these cases may have on practice in Intensive Care.
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This chapter discusses a framework for and process of ethical decision making in the context of the discipline, theories, and principles of ethics. Daily decision making within the Hospital Ethics Committee is considered and some of the emerging ethical issues in anaesthesia are discussed.
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Best Pract Res Clin Anaesthesiol · Dec 2006
Limiting and rationing treatment in paediatric and neonatal intensive care.
In this chapter I consider the ethical decisions surrounding the provision and limitation of treatment offered to children requiring intensive care. I focus on the processes surrounding end of life decision making and consider how the concepts of futility, burden and uncertainty should impact upon these decisions. ⋯ It does take a practical approach to the issues faced by considering why we should engage in life limiting discussions; When they should occur; Who should be involved; How they should be carried out; and where and by what means withholding or withdrawal should occur. I have drawn the discussions closer to clinical practice with the intention of making them more useful, for those engaged in direct patient care, than those focused around philosophical principles.
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The incidence of substance abuse amongst anaesthetists in the United Kingdom is unknown. In the interests of patient safety, it is essential that the dependent doctor is identified and entered into a treatment regime. No national strategy is in place to treat and, where possible, return the anaesthetist in recovery to work. ⋯ Residential care probably provides the greatest hope of success. In the United States, Canada, Australia and New Zealand 'impaired physician' programmes are in place which allow some doctors to return to work, initially under strict supervision. Registration with a self-help organisation is essential; a list of such groups in the United Kingdom is appended.
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It is not possible to generalise about the way in which increasing years affect the performance of an individual anaesthetist. Physical and mental deterioration occurs as we age; most anaesthetists will be able to reach the normal retirement age of 65 years without that deterioration affecting their clinical practice. In some, however, decreasing competence and an unwillingness to embrace a continuing education regime may offer a direct threat to patient safety. ⋯ Continuing involvement in the on-call rota is a potent stressor. Airline pilots are required to retire at 60 years; the feasibility and desirability of applying this process to anaesthetists are discussed. Employers have a duty to provide employees with adequate and achievable demands in relation to their agreed hours of work and to have in place policies and procedures to offer adequate support.