Humanizing Intensive Care: Theory, Evidence, and Possibilities

Abstract

Intensive care units (ICUs) are showcases for many of the most stunning technological advances in medicine. Survival from once routinely fatal diseases is rapidly increasing [1]. Unfortunately, the severity of illness and the invasiveness of intensive therapies can make the ICU a brutal place for all involved [2, 3]. Patients report violations of their dignity and most survivors and family members experience symptoms of anxiety, depression, or posttraumatic stress disorder (PTSD) [4]. For patients who die in or shortly after the ICU stay, many of the deaths will have been deformed by an overemphasis on medical technology [5]. ICU admission may threaten the individual’s sense of self, both from the threat of annihilation through death and the dehumanization attendant to critical illness, its treatments, and clinician behaviors [2]. The sometimes brutal realities of contemporary ICU care are generating appropriate debates about how to humanize the ICU. Several possible solutions have been proposed [6], but the topic has often been associated with a lack of clear thinking, particularly in the ICU.

The dehumanization of the ICU has persisted for many reasons, including structural/ organizational problems and defense mechanisms and cognitive errors on the part of clinicians. These cognitive errors are understandable, even predictable. The ICU is stressful and disorienting enough that all participants – clinicians, patients, and families – are prone to misperceive the situation in ways that contribute to dehumanization. While clinician diagnostic errors have been well described by cognitive psychologists in recent decades [7], the risks of misapprehension and cognitive errors related to human aspects of the ICU experience are also endemic and merit consideration. Increasingly sophisticated work in cognitive psychology and judgment and decision making may shed considerable light on the problems of dehumanization in the ICU. In this chapter, we consider theory, evidence, and early solutions with an eye toward clarifying the cognitive errors and blind spots that often interfere with humanization in the ICU.