N. Zamperetti et al., Bioethical issues related to continuous renal replacement therapy in intensive care patients, INTEN CAR M, 26(4), 2000, pp. 407-415
Objective: To examine the ethical approach of intensivists and nephrologist
s to continuous renal replacement therapy (CRRT).
Design: A questionnaire.
Setting: The First International Course on Critical Care Nephrology.
Participants: The participants in the course (around 500).
Results: Most participants think that establishing ethical criteria for man
aging CRRT is a medical task, as clinicians have adequate criteria for defi
ning futility. However, many responders would grant the request of starting
futile CRRT or would maintain it if requested by the family. Only 55 % bel
ieve that informed consent is necessary for initiating CRRT; one out of fou
r would start or maintain unwanted life-saving CRRT. In case of lack of equ
ipment, the majority would select the patients, excluding the worst one or
on a "first-come, first-served" basis. Withholding and withdrawing are rega
rded differently by most responders. Again, most think that every vital sup
port should be withdrawn when futile, but practical and psychological aspec
ts still influence the final decision. Responders think that ethics critica
l care committees can help in the management of ethical problems in ICU.
Conclusions: Our results show that several ethical questions are still unso
lved and that practical and psychological aspects of the treatment process
can be stronger than bioethical principles.