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

The ethically charged question of what constitutes appropriate levels of care is both inevitable and particularly complex in intensive care units (ICUs), where limited resources, uncertain prognosis, and potentially conflicting values among patients, families, and ICU professionals all cohabit. While various tools have been developed to support discussions and decision-making around levels of care, they are often developed without the individuals who will ultimately use them and they fail to address the lack of interprofessional collaboration and communication between ICU professionals, a factor known to contribute to inappropriate levels of care. Living labs and the living ethics stance, which aim both to enhance collaboration and communication, represent promising research orientations for addressing this issue. This paper reports the process and outcomes of a living ethics project, which took the form of a living lab, to address the issue of inappropriate levels of care in the ICU. Special emphasis is granted to the evaluation of outcomes by participating stakeholders. This study highlights that, although inappropriate levels of care is a deeply concerning issue for which concrete contextual solutions can be envisioned, engaging in a participatory research process can be particularly challenging for overburdened critical care professionals. This difficulty stems not only from the multifactorial and emotionally charged nature of the issue, but also from the demanding context in which ICU professionals operate.