RESEARCH PROPOSAL

Research Proposal

Research Proposal

Chapter 1: Introduction

Background

Intensive Care Units (ICUs) have improved the survival of many seriously ill patients. Unfortunately, despite the improved outcomes, some patients do not survive. The majority of patients used to die in ICUs after cardiopulmonary resuscitation in the past. The majority of deaths in ICUs today, however, occur after the withholding or withdrawing of life-sustaining treatments. Although it is widely accepted that informed consent by a patient or surrogate is required before medical treatment, the attitude toward the need for informed consent for forgoing life-sustaining treatments differ among countries.

According to the President's Commission, the voluntary choice of a competent and informed patient or surrogate should determine whether or not life-sustaining therapies should be undertaken or continued, just as such choices provide the basis for decisions about other medical treatments. European as opposed to North American physicians still are guided by paternalism and beneficence more than autonomy. In fact, there is considerable variation in the manner that North American and European physicians communicate with patients and families regarding withholding or withdrawing life-sustaining therapies or end-of-life limitations and therapy. The present study was undertaken in a single ICU to evaluate end-of-life limitations and their communication based on physician training.

Aims and objectives of the study

Aims and objectives of the paper is to examine the practice and ethical attitudes of intensive care doctors in Hong Kong and to compare findings with those from European studies.Chapter 2: Literature Review

In the highly technical milieu of an intensive care unit (ICU), teams of physicians and nurses provide high quality care aimed at the recovery of the patients in their charge. An understanding of the other team members' perspectives (cf. [Oberley and Hughes, 2001]) is an essential component of collaboration. In Sweden, the National Board of Health and Welfare's directives on quality systems in healthcare state that patients and their significant others are to be treated with concern and respect, be informed, and be invited to participate in the care (The National Swedish Board of Health and Welfare, 1996).

The individual professionals in a healthcare team may have contrasting experiences from their daily clinical work. Nurses have reported difficulties in performing their duties due to a lack of understanding as well as differing attitudes towards the patient among the team members ( [Beeby, 2000]). According to [Takman and Severinsson, 1999], the way in which healthcare professionals experience encounters with patients in acute clinical settings can be understood as their ability to understand the patients' different ways of communicating experienced suffering.

According to [Granberg et al., 1999], patients whose loved one was at their bedside in ICUs suffered fewer hallucinations. In the critical care milieu, patients are often incapable of making decisions regarding their own care (Wasser et al., 2001]). The significant others will then be expected, as suggested by [Oberley and Hughes, 2001], to act in the interest of the patient with regard to medical care decisions. [Pochard et al., 2001] reported that more than two thirds of the significant others who ...