A Living Ethics Project to Address Inappropriate Levels of Care: Process and Outcomes.

Area of Science:

• Medical Ethics
• Critical Care Medicine
• Health Services Research

Background:

• Determining appropriate care levels in intensive care units (ICUs) is ethically complex due to resource limits, uncertain prognoses, and value conflicts.
• Existing decision-making tools often lack end-user input and fail to address interprofessional communication gaps, contributing to inappropriate care levels.
• Living labs and living ethics offer promising frameworks to enhance collaboration and communication in addressing these issues.

Purpose of the Study:

• To report the process and outcomes of a living ethics project, structured as a living lab, aimed at tackling inappropriate levels of care in the ICU.
• To evaluate the outcomes of this participatory approach from the perspective of involved stakeholders.
• To explore the feasibility and challenges of implementing collaborative research in demanding critical care environments.

Main Methods:

• A living lab methodology was employed, integrating a living ethics stance to foster interprofessional collaboration and communication.
• The project focused on addressing the issue of inappropriate levels of care within the intensive care unit setting.
• Stakeholder evaluation was a key component for assessing the project's outcomes and impact.

Main Results:

• The study identified that inappropriate levels of care in ICUs is a significant concern with potential for context-specific solutions.
• Participatory research processes, while valuable, present considerable challenges for critical care professionals.
• These challenges arise from the complex, emotionally charged nature of the problem and the demanding ICU work environment.

Conclusions:

• Concrete solutions for inappropriate ICU care levels can be developed through participatory research, such as living labs.
• Engaging overburdened critical care professionals in research is difficult but essential for addressing complex ethical and practical issues.
• Future research should consider the practical constraints and emotional load experienced by ICU staff when designing collaborative studies.