The necessity of ethical support for health care professionals in Intensive Care: Role and competencies of the Clinical Ethics Committee



Palabras clave:

decision-making process, ethical support, clinic ethics committee, advanced directive, intensive medicine unit


Promoting measures that aim to mitigate discrepancies in the decision-making process, ensuring adequate training of physicians in the ethical aspect of care, and incrementing the wellbeing of patients and their families are becoming the principal objectives for high-quality care, especially in the Intensive Medicine Unit (ICU). In this paper, we’re going to deal with the implementation of a specific ethics support for the ICU health care professionals, and considering the advanced Spanish experience on this matter, it deals with the current potentialities and limits of CEC’s role to improve the quality of health care assistance.

Biografía del autor/a

Marta Perin

Post graduated student with a Master's Degree in Philosophical Sciences. She was a trainee at the Observatorio de Bioética y Derecho from April to June. Her research fields are advance care planning; ethical issues of dementia and neurodegenerative diseases; phenomenology and ethics consultation.


Altisent R., Martin-Espildora N., Delgado-Marroquin Mt. (2013) Health care ethics consultation: Individual consultant or Committee model? Pros and Cons. The American Journal of Bioethics 13, 2, 25-27.

American Society for Bioethics and Humanities (2011) Core competencies for healthcare ethics Consultation: The report of the American Society for Bioethics and Humanities”, 2nd ed. Glenview, IL.

Aulisio, M. & Arnold, R (2008) Role of the ethics committee - Helping to address value conflicts or uncertainties, Chest. 134, 417-424.

Casado, M., De Lecuona, I., Royes, A. (2013) Sobre las voluntades anticipadas: aspectos bioètico , juridicos y sociales, Revista Española de Medicina Legal,39,1, 26-31.

Comité de Bioética de Catalunya (2013) La qualitat en els comitès d’etica assistencial, December, available at:

Council Of Europe (1997) Convention for the Protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine”, Oviedo, 4.IV.1997, available at:

Cranford, R.E. & Doudera, A.E. (1984) The Emergence of Institutional Ethics Committees, The Journal of Law, Medicine & Ethics, 12, 1, 13-20.

Departament de Salut de la Generalitat de Catalunya (2019) Informe sobre el registro de voluntats anticipades, gener. available at:

European Parliament & The Council Of The European Union (2014) Regulation (EU) 536/2014 of the European Parliament and of the Council of 16 April 2014 on clinical trials on medicinal products for human use, and repealing Directive 2001/20/EC, Official Journal of the European Union, L 158, 27 May 2014.

Fletcher Jc & Siegler M. (1996) What Are the Goals of Ethics Consultation? A Consensus Statement, The Journal of Clinical Ethics 7, 2, 122-6., p. 4.

Førde, R. & Hansen, T.W. (2014) Do organizational and clinical ethics in a hospital setting need different venues?, HEC Forum Jun; 26, 2, 147-58.

Heras La Calle, G., Martin, M.C.& Nin, N. (2017) Seeking to humanize intensive care, Rev Bras Ter Intensiva Jan-Mar 29, 1, 9-13.

Leder, N., Schwarskopf, D., Reinhart, K.,Witte, O.W., Pfeifer, R., & Hartog, S.C. (2015) The Validity of Advance Directives in Acute Situations: A Survey of Doctors’ and Relatives’ perceptions From an Intensive Care Unit, Dtsch Arztebl Int., Oct 112, 43, 723-729.

Luce, J.M. (2009) End-of-life decision making in the ICU, Clin Chest Med., Mar 30,1, 181-94.

Mcclimans L, Pressgrove, G, Campell, E. J. (2019) Objectives and outcomes of clinical ethics services: a Delphi study. J Med Ethics, published online first:04 September.

Nyholm, L., Koskien, C. (2017) Understanding and safeguarding patient dignity in intensive care, Nursing Ethics Jun; 24(4), 408-418.

Pedersen, R., Akre, V., Førde, R. (2009) Barriers and challenges in clinical ethics consultations: The experiences of nine clinical ethics committees, Bioethics 23, 8, 460-469.

Peicius, E., Blazeviciene, A., Kaminskas R. (2017) Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals, BMC Med Ethics, 18, 40.

Petrini, C., Ricciardi, W. (2017) Clinical ethics and the role of clinical ethics committees: proposals for a revival, Ann Ist Super Sanità 53, 3, 183-184.

Pope Tm (2011) Legal Briefing: Healthcare Ethics Committees, The Journal of Clinical Ethics, Spring, 22, 1, 74-93.

Quill, C. M., Sussman, B.L., Quill, T.E. (2015) Palliative Care, Ethics, and the Law in the Intensive Care Unit, Critical Care Nursing Clinics of North America, September, 27, 3, 383-394.

Ruth, D., Azoulay, E., Ricou, B., Dekeyser Ganz, F., Max, A., Michalsen A., and then ‘…’ Appropricus Study Group of the Ethics Section of the European Society of Intensive Care Medicine (2014) Inappropriate Care in European ICUs Confronting Views From Nurses and Junior and Senior Physicians, Chest. Aug, 146, 2, 267-275.

Schildmann J, Nadolny S., Haltaufderheide J., Gyels M., Vollmann J., Bausewein C. (2019) Ethical case interventions for adult patients. Cochrane Database of Systematic Reviews Issue 7. Art. No.: CD012636.

Schneiderman Lj, Gilmer T., Teetzel Hd. (2000) Impact of ethics consultation in the intensive care setting: a randomized controlled trial, Crit. Care Medicine, Dec., 28, 12, 3920-4.

Solsona Duran, J., Zapatero Ferrándiz, A. (2012) Voluntades anticipadas y consentimiento informado en medicina intensiva. In Cabré, L. (Coord.) Bioética y Medicina Intensiva, Thomson Reuters, Pamplona, pp. 58-64.

Sudore, R.L., Lum, H.D., You, J.J., Hanson, L.C., Meier, D.E., Pantilat, S.Z., and then ‘…’ Heyland, D.K. (2017) Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel, J Pain Symptom Manage, May; 53, 5, 821-832.

Turnbull Ae, Bosslet Gt, Kross Ek. (2019) Aligning use of intensive care with patient values in the USA: past, present, and future, Lancet Respir Med, Jul; 7, 7, 626-638.

UN General Assembly (1948) Universal Declaration of Human Rights, 10 December, 217 A (III), available at:

UNESCO (2005) Universal Declaration on Bioethics and Human Rights, 19 October, available at:

Vincky, J.K., Gasner, M.R. (1992) Advance directives: implications for critical care, Crit Care Med., Jul; 20, 7, 1027-1031.

Visser M., Deliens L., Houttekier D. (2014) Physician Related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review, Crit Care. Nov 18; 18, 6, 604.

Voigit Lp, Rajendram P., Shuman Ag, Kamat S., Mccabe Ms, Kostelecky N., Halpern Na. (2015) Characteristics and Outcomes of Ethics Consultations in an Oncologic Intensive Care Unit, J Intensive Care Med. Oct; 30, 7, 436-42.

Wolf At., Hite Kr., Epstein Eg, Enfield Kb. (2019) Palliative Care and Moral Distress: An Institutional Survey of Critical Care Nurses, Crit Care Nurse. Oct; 39, 5, 38-49.




Cómo citar

Perin, M. (2020). The necessity of ethical support for health care professionals in Intensive Care: Role and competencies of the Clinical Ethics Committee. Revista De Bioética Y Derecho, (49), 125–139.



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