Elective non-therapeutic intensive care and the four principles of medical ethics

• Published in: Journal of medical ethics Vol. 39; no. 3; pp. 139 - 142
• Main Authors: Baumann, Antoine, Audibert, Gérard, Guibet Lafaye, Caroline, Puybasset, Louis, Mertes, Paul-Michel, Claudot, Frédérique
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Institute of Medical Ethics 01-03-2013; BMJ Publishing Group; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: Analysis; Autonomy; Beneficence; Bioethics; Blood & organ donations; Brain Death; Clinical Ethics; Consent; Critical Care - ethics; Death; Donation of organs, tissues, etc; Donation/Procurement of Organs/Tissues; Elactive ventilation; Ethical Theory; Ethics, Medical; Heart Arrest; Humanities and Social Sciences; Humans; Intensive care; Intensive care units; Life Support Care - ethics; Medical ethics; Medical Futility; Organ donation; Organ preservation; Paternalism; Personal Autonomy; Principle-Based Ethics; Principles; Respiration, Artificial - ethics; Social Justice; Sociology; Tissue and Organ Procurement - ethics; Tissue donation; Tissue Donors - supply & distribution; Transplantation; Transplants & implants; Ventilation; Ventilation systems; Withholding Treatment - ethics
• ISSN: 0306-6800; 1473-4257
• DOI: 10.1136/medethics-2012-100990

The chronic worldwide lack of organs for transplantation and the continuing improvement of strategies for in situ organ preservation have led to renewed interest in elective non-therapeutic ventilation of potential organ donors. Two types of situation may be eligible for elective intensive care: patients definitely evolving towards brain death and patients suitable as controlled non-heart beating organ donors after life-supporting therapies have been assessed as futile and withdrawn. Assessment of the ethical acceptability and the risks of these strategies is essential. We here offer such an ethical assessment using the four principles of medical ethics of Beauchamp and Childress applying them in their broadest sense so as to include patients and their families, their caregivers, other potential recipients of intensive care, and indeed society as a whole. The main ethical problems emerging are the definition of beneficence for the potential organ donor, the dilemma between the duty to respect a dying patient's autonomy and the duty not to harm him/her, and the possible psychological and social harm for families, caregivers other potential recipients of therapeutic intensive care, and society more generally. Caution is expressed about the ethical acceptability of elective non-therapeutic ventilation, along with some proposals for precautionary measures to be taken if it is to be implemented.