Andrej Michalsen – författare

This book addresses the ethical problems that physicians have to face every day while caring for critically ill patients. Advances in medical technology, ageing societies worldwide, and their increased demands on health care systems have, on the one hand, led to better care and remarkable longevity in many parts of the world. On the other hand, however, improved treatments in many medical fields, amongst others in emergency and critical care, have resulted in more patients surviving with reduced quality of life. This entails tradeoffs for many patients, their families, and the teams caring for them. At the same time, health care expenditures have risen dramatically and have to be balanced against costs for other public goods. Finally, the humane aspects of care have often failed to keep pace with the remarkable technological strides made in recent years.In this book, experts in their respective fields describe compelling ethical challenges resulting from these discrepancies and discuss potential solutions. The book is primarily intended for clinicians who care for two of the most vulnerable patient subpopulations – those being treated in ambulances or emergency rooms, and those being treated at intensive care units – due in part to the fact that they may be temporarily or permanently incapacitated. Core medical skills, such as diagnosis and predicting outcomes, as well as implementing treatment, remain challenging. However, without adequate communication and collaboration both within the inter-professional treatment teams and between the teams and the patients/their families, delivering excellent care is difficult at best. Therefore, the so-called “soft skills” are given the attention they deserve in order to overcome the gap between technological progress and interpersonal standstill.

This book addresses the ethical problems that physicians have to face every day while caring for critically ill patients. Advances in medical technology, ageing societies worldwide, and their increased demands on health care systems have, on the one hand, led to better care and remarkable longevity in many parts of the world. On the other hand, however, improved treatments in many medical fields, amongst others in emergency and critical care, have resulted in more patients surviving with reduced quality of life. This entails tradeoffs for many patients, their families, and the teams caring for them. At the same time, health care expenditures have risen dramatically and have to be balanced against costs for other public goods. Finally, the humane aspects of care have often failed to keep pace with the remarkable technological strides made in recent years.In this book, experts in their respective fields describe compelling ethical challenges resulting from these discrepancies and discuss potential solutions. The book is primarily intended for clinicians who care for two of the most vulnerable patient subpopulations – those being treated in ambulances or emergency rooms, and those being treated at intensive care units – due in part to the fact that they may be temporarily or permanently incapacitated. Core medical skills, such as diagnosis and predicting outcomes, as well as implementing treatment, remain challenging. However, without adequate communication and collaboration both within the inter-professional treatment teams and between the teams and the patients/their families, delivering excellent care is difficult at best. Therefore, the so-called “soft skills” are given the attention they deserve in order to overcome the gap between technological progress and interpersonal standstill.

This book addresses the ethical problems that physicians have to face every day while caring for critically ill patients. Advances in medical technology, ageing societies worldwide, and their increased demands on health care systems have, on the one hand, led to better care and remarkable longevity in many parts of the world. On the other hand, however, improved treatments in many medical fields, amongst others in emergency and critical care, have resulted in more patients surviving with reduced quality of life. This entails tradeoffs for many patients, their families, and the teams caring for them. At the same time, health care expenditures have risen dramatically and have to be balanced against costs for other public goods. Finally, the humane aspects of care have often failed to keep pace with the remarkable technological strides made in recent years.In this book, experts in their respective fields describe compelling ethical challenges resulting from these discrepancies and discuss potential solutions. The book is primarily intended for clinicians who care for two of the most vulnerable patient subpopulations – those being treated in ambulances or emergency rooms, and those being treated at intensive care units – due in part to the fact that they may be temporarily or permanently incapacitated. Core medical skills, such as diagnosis and predicting outcomes, as well as implementing treatment, remain challenging. However, without adequate communication and collaboration both within the inter-professional treatment teams and between the teams and the patients/their families, delivering excellent care is difficult at best. Therefore, the so-called “soft skills” are given the attention they deserve in order to overcome the gap between technological progress and interpersonal standstill.

In this book, part of the European Society of Intensive Care Medicine (ESICM) textbook series, experts in the field of clinical ethics describe basic principles of clinical ethics and ethical reasoning, the fundamental pillars of intensive care medicine as well as the decision-making processes necessary to arrive at appropriate decisions for each individual patient. Specifically, the complex decision-making process, with regard to limiting life-sustaining therapies and integrating palliative care into intensive care, are expounded. Furthermore, the still controversial topics of ethical climate, proportionate care, and prioritization are elaborated upon. The so-called “soft skills” of inter-professional communication and co-operation are given the attention they deserve in order to overcome the gap between technological progress and interpersonal standstill. Finally, widely accepted ethical values and principles were challenged by the Covid-19 pandemic, forcing clinicians to elaborate recommendations regarding the prioritization of scarce resources.The book will be an invaluable tool for clinicians to understand ethical principles and reasoning to contend ethical challenges in intensive care medicine across the boundaries of disciplines and professions, in order to provide an appropriate individual plan of treatment for their patients.

In this book, part of the European Society of Intensive Care Medicine (ESICM) textbook series, experts in the field of clinical ethics describe basic principles of clinical ethics and ethical reasoning, the fundamental pillars of intensive care medicine as well as the decision-making processes necessary to arrive at appropriate decisions for each individual patient. Specifically, the complex decision-making process, with regard to limiting life-sustaining therapies and integrating palliative care into intensive care, are expounded. Furthermore, the still controversial topics of ethical climate, proportionate care, and prioritization are elaborated upon. The so-called “soft skills” of inter-professional communication and co-operation are given the attention they deserve in order to overcome the gap between technological progress and interpersonal standstill. Finally, widely accepted ethical values and principles were challenged by the Covid-19 pandemic, forcing clinicians to elaborate recommendations regarding the prioritization of scarce resources.The book will be an invaluable tool for clinicians to understand ethical principles and reasoning to contend ethical challenges in intensive care medicine across the boundaries of disciplines and professions, in order to provide an appropriate individual plan of treatment for their patients.

Der medizinisch-technische Fortschritt führt verbunden mit der demographischen Entwicklung dazu, dass immer mehr, und v.a. ältere und vorerkrankte Menschen intensivmedizinisch behandelt werden. Die Vorhersage des Behandlungsergebnisses bleibt dabei häufig schwierig. Im Verlauf einer intensivmedizinischen Behandlung geraten Ärzte und Pflegekräfte oft in ein Spannungsfeld zwischen dem, was technisch möglich ist, und dem, was dem Patientenwillen entspricht. Immer wieder wird man deshalb bei Intensivpatienten mit sehr ernster Prognose entscheiden müssen, den Therapieumfang zu begrenzen oder das Therapieziel vom kurativen Ansatz zur Symptomkontrolle und Begleitung zu verändern. Hier sind für das therapeutische Team Entscheidungshilfen und konkrete Handlungsanleitungen, basierend auf ethischen Überlegungen, dem Willen des Patienten und juristischen Regularien, hilfreich. Das vorliegende Werk beschäftigt sich u.a. mit folgenden Themen: ethische Prinzipien, juristische Grundlagen, Patientenautonomie, Entscheidungsfindung und operative Umsetzung bei Therapiebegrenzung und Therapiezieländerung, Einheit von Patient und Familie, kulturelle und religiöse Einflüsse sowie Konflikte und Burnout im Behandlungsteam. Für alle auf Intensivstationen tätigen Ärzte und Pflegekräfte, die sich mit schwierigen Entscheidungen auseinandersetzen.

Der medizinisch-technische Fortschritt führt verbunden mit der demographischen Entwicklung dazu, dass immer mehr, und v.a. ältere und vorerkrankte Menschen intensivmedizinisch behandelt werden. Die Vorhersage des Behandlungsergebnisses bleibt dabei häufig schwierig. Im Verlauf einer intensivmedizinischen Behandlung geraten Ärzte und Pflegekräfte oft in ein Spannungsfeld zwischen dem, was technisch möglich ist, und dem, was dem Patientenwillen entspricht. Immer wieder wird man deshalb bei Intensivpatienten mit sehr ernster Prognose entscheiden müssen, den Therapieumfang zu begrenzen oder das Therapieziel vom kurativen Ansatz zur Symptomkontrolle und Begleitung zu verändern. Hier sind für das therapeutische Team Entscheidungshilfen und konkrete Handlungsanleitungen, basierend auf ethischen Überlegungen, dem Willen des Patienten und juristischen Regularien, hilfreich. Das vorliegende Werk beschäftigt sich u.a. mit folgenden Themen: ethische Prinzipien, juristische Grundlagen, Patientenautonomie, Entscheidungsfindung und operative Umsetzung bei Therapiebegrenzung und Therapiezieländerung, Einheit von Patient und Familie, kulturelle und religiöse Einflüsse sowie Konflikte und Burnout im Behandlungsteam. Für alle auf Intensivstationen tätigen Ärzte und Pflegekräfte, die sich mit schwierigen Entscheidungen auseinandersetzen.

Der medizinisch-technische Fortschritt und die demographische Entwicklung sowie die Erwartungen und Anspruchshaltungen in der Bevölkerung haben in den letzten Jahren zu einer erheblichen Ausweitung intensivmedizinischer Maßnahmen geführt. Die Festlegung eines individuell angemessenen Therapieziels und die Vorhersage des Erfolgs eines intensivmedizinischen Behandlungsverfahrens bleiben dabei häufig schwierig. Das Buch bietet dafür eine konkrete Orientierung. Es vermittelt auf der Basis klinisch-ethischer Grundlagen Entscheidungshilfen und konkrete Handlungsanleitungen für die individuell angemessene Bestimmung von Therapieziel und Therapieumfang. Es richtet sich an alle auf Intensivstationen tätigen Ärzte und Pflegefachkräfte, die im Spannungsfeld zwischen dem medizinisch Machbaren und dem Willen des Patienten stehen und qualifizierte Unterstützung suchen. Themen des Buches sind u.a. ethische und juristische Grundlagen, Indikationsstellung und Prognostizierung, der Wille der Patienten und die Rolle der Zugehörigen, Cultural Diversity, interprofessionelle Entscheidungsfindung, Kommunikation im Team und mit den Patienten, Limitierung lebensverlängernder Therapiemaßnahmen und Palliativmedizin, Todesverständnis und Organentnahme, Artificial Intelligence und zukünftige klinisch-ethische Herausforderungen.