Le réanimateur en dehors de la réanimation : quelle place ? quels enjeux éthiques ?

Réanimateur en dehors du service : pourquoi ? enjeux ?

Abstract

Intensivists are often called upon in wards or emergency departments for advice. These requests typically occur in two distinct circumstances, each presenting different ethical considerations. The first scenario involves assessing the clinical condition of a patient with organ failure. In such cases, expertise in life sustaining therapies is necessary, like any other organ specialist. The second circumstance concerns requests to withhold or withdraw treatment. Beyond legal requirements for collegiality, intensivists may be called upon to make decisions regarding treatment limitations. While essential, this often underestimated activity can lead to ethical conflicts and contribute to burnout, especially during on-call periods when such requests are frequent. To mitigate these challenges, several solutions are proposed: anticipating goals of care definition, patient involvement with advance directives, clearly distinguishing between requests for advice and treatment limitations, and providing training in intensive care management for junior doctors.