Role of clinical ethicists in making decisions about levels of care in the intensive care unit.

CRITICALCARENURSE Vol 29, No. 2, APRIL 2009 77 family challenged the health care team’s recommendations and insisted that their mother be readmitted to the ICU so that aggressive life-sustaining treatment would continue. This case, although Canadian, is relevant to ICU settings throughout North America. The purpose of this discussion is not to provide an indepth ethical analysis, but rather to use the case of Mrs H to characterize one type of health care situation that clinical ethicists could help facilitate. Medical recommendations such as those involved in the care of Mrs H are made to prevent the “revolving door” patient, who according to ICU teams will receive no medical benefit if returned to the ICU. Decisions not to readmit are euphemistically referred to by some ICU staff as the “one-way ticket out of ICU” or “celestial transfer.” Such language shared between colleagues reflects a coping strategy, a “gallows humor,” intended to manage difficult feelings like sadness, anger, grief, sympathy, or moral distress. Cases like that of Mrs H are of Karen Faith, MEd, MSc, RSW Paula Chidwick, PhD Role of Clinical Ethicists in Making Decisions About Levels of Care in the Intensive Care Unit Ethics