Abstract
Intensive care medicine is a specialty fraught with difficulties, some overt, some covert. The most obvious clinical challenge is in managing the most unwell patients in the hospital, for whom numerous interwoven comorbidities have led to multiple organ failure. Our days are punctuated with high stakes decision-making, finessing treatment strategies, and continuously rebalancing benefit and risk. Further tangible stresses arise from workforce shortages, economic constraints, and administrative chores. Less obvious to the casual observer, however, is a more subtle layer of complexity that underpins the decisions we make: the ethical ramifications of intensive care medicine. Medical ethics features far less prominently in our education than glycolysis, the ‘sepsis six’ or the contents of a bag of Hartmann’s solution. Most of us will have followed recent high-profile legal cases involving critically ill patients unable to express their own opinions, and felt the echoes of such conflicts as we go about our own work. The 2017 case of Charlie Gard will be etched into most of our memories. Some of you may have been directly involved with this or similar distressing cases. These scenarios place untold pressure on the entire healthcare team. It will never be possible to avert these conflicts, but acquiring a better understanding of medical ethics bolsters the framework for the care we deliver. It is imperative that we are knowledgeable about the system that protects the rights of our patients. Just like medicine, medical ethics is both complex and dynamic. New acts and laws can substantially change the way in which certain situations must be approached. In this edition of the Journal of the Intensive Care Society, Innes and colleagues provide the first of a two-part practical guide to medical ethics relevant to intensive care medicine. The articles are the product of an Intensive Care Society seminar dedicated to considering those components of medical ethics that specifically apply to the setting of an intensive care unit. In this first part, the topics of capacity and a patient’s best interest are eloquently discussed and illustrated with case studies. Part two follows in the next edition of the journal. Together, these articles provide a superb up-to-date guide to the common ethical conundrums we encounter on intensive care units.
Writing this foreword at the end of November in order that it is processed in time to drop through your letterbox, this month, I am conscious that our busiest time of year currently lies ahead but by the time you read this it should have passed. The winter can be tough for all involved in intensive care. The shortening days wreak havoc with our body clock, the relentless rain exacerbates the misery of commuting and the temperature seems to be inversely correlated with the number of admissions that come through the doors of the emergency department. The combination of seasonal affective disorder with increased workload affects all of us in some way or other. The popular festive carol ‘Deck the Halls’ proclaims that this darkest part of winter ‘tis the season to be jolly.’ Whilst it is true that I may have a number of Scrooge-positive single nucleotide polymorphisms, perhaps this time of year should actually be ‘tis the season to look out for one another.’ So think about your colleagues this winter and remember that the most valuable gift you can give is time.