The Ethics of Trauma Care: What Interventional Radiologists Should Know

The last issue of Seminars in Interventional Radiology highlighted multiple ways interventional radiologists (IRs) can play a vital role in trauma care. However, this care can also raise multiple ethical challenges that differ from other areas of practice. One main difference is the urgency at which decision-making occurs, prohibiting extensive deliberation and discussion. In this article, we use a case to discuss three salient ethical issues that may arise when answering an IR trauma consult: allocation of limited resources, emergent consent, and requests for potentially inappropriate interventions. We conclude with a stepwise framework for navigating an ethically challenging trauma case.

Publication History

Article published online:
03 June 2021

• References

• 1 Repine TB, Lisagor P, Cohen DJ. The dynamics and ethics of triage: rationing care in hard times. Mil Med 2005; 170 (06) 505-509
• 2 Schwartz L, Hunt M, Redwood-Campbell L, de Laat S. Ethics and emergency disaster response. Normative approaches and training needs for humanitarian health care providers. In: Disaster Bioethics: Normative Issues When Nothing Is Normal. Springer; 2014: 33-48
• 3 Moskop JC, Iserson KV. Triage in medicine, Part II: Underlying values and principles. Ann Emerg Med 2007; 49 (03) 282-287
• 4 Shnayder MM, Keller EJ, Makary MS. COVID-19 ethics: what interventional radiologists need to know. J Vasc Interv Radiol 2020; 31 (10) 1720-1723
• 5 Daniels N. Just Health: Meeting Health Needs Fairly. Cambridge, New York: Cambridge University Press; 2008
• 6 ACR-SIR-SPR Practice Parameter on Informed Consent for Image-Guided Procedures. American College of Radiology, Society of Interventional Radiology, and Society for Pediatric Radiology; 2016
• 7 Jonsen AR, Siegler M, Winslade WJ. Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine. 7th ed.. New York: McGraw-Hill Medical; 2010
• 8 Menikoff J. Law and Bioethics: An Introduction. Washington, DC: Georgetown University Press; 2001
• 9 Veatch RM. Implied, presumed and waived consent: the relative moral wrongs of under- and over-informing. Am J Bioeth 2007; 7 (12) 39-41 , discussion W3-4
• 10 DeMartino ES, Dudzinski DM, Doyle CK. et al. Who decides when a patient can't? Statutes on alternate decision makers. N Engl J Med 2017; 376 (15) 1478-1482
• 11 Appelbaum PS, Grisso T. Assessing patients' capacities to consent to treatment. N Engl J Med 1988; 319 (25) 1635-1638
• 12 Suah A, Angelos P. How should trauma patients' informed consent or refusal be regarded in a trauma bay or other emergency settings?. AMA J Ethics 2018; 20 (05) 425-430
• 13 Bosslet GT, Pope TM, Rubenfeld GD. et al; American Thoracic Society ad hoc Committee on Futile and Potentially Inappropriate Treatment, American Thoracic Society, American Association for Critical Care Nurses, American College of Chest Physicians, European Society for Intensive Care Medicine, Society of Critical Care. An official ATS/AACN/ACCP/ESICM/SCCM policy statement: responding to requests for potentially inappropriate treatments in intensive care units. Am J Respir Crit Care Med 2015; 191 (11) 1318-1330
• 14 Keller EJ, Rabei R, Heller M, Kothary N. Perceptions of futility in interventional radiology: a multipractice systematic qualitative analysis. Cardiovasc Intervent Radiol 2021; 44 (01) 127-133
• 15 Einav L, Finkelstein A, Mullainathan S, Obermeyer Z. Predictive modeling of U.S. health care spending in late life. Science 2018; 360 (6396): 1462-1465
• 16 Kon AA, Shepard EK, Sederstrom NO. et al. Defining futile and potentially inappropriate interventions: a policy statement from the Society of Critical Care Medicine Ethics Committee. Crit Care Med 2016; 44 (09) 1769-1774
• 17 Müller R, Kaiser S. Perceptions of medical futility in clinical practice - a qualitative systematic review. J Crit Care 2018; 48: 78-84
• 18 Fumis RRL, Junqueira Amarante GA, de Fátima Nascimento A, Vieira Junior JM. Moral distress and its contribution to the development of burnout syndrome among critical care providers. Ann Intensive Care 2017; 7 (01) 71
• 19 Bernacki RE, Block SD. American College of Physicians High Value Care Task Force. Communication about serious illness care goals: a review and synthesis of best practices. JAMA Intern Med 2014; 174 (12) 1994-2003
• 20 May P, Normand C, Cassel JB. et al. Economics of palliative care for hospitalized adults with serious illness: a meta-analysis. JAMA Intern Med 2018; 178 (06) 820-829
• 21 Sakran JV, Maa J, Masiakos PT. Turning experience into action: this is our lane. Curr Trauma Rep 2020; 6 (01) 5-9