Ethical dilemmas are not new to health care, but they seem to have either become more pervasive in practice or health care providers have become more sensitive to such issues. With advancing technology and changes in health care delivery, ethical dilemmas are becoming part of our daily practice. This is apparent by the fact that everyone seems to have a story these days about ethical dilemmas they have experienced. For that reason, the articles in this issue of Critical Care Nursing Quarterly (CCNQ 22:3) are rich in case studies, reflecting both positive and negative outcomes. The authors learned about themselves and their health care role as they put their experiences into words, and we hope that their shared experiences will help others who become involved in similar circumstances.
The articles by Simko and Husted deal with the application of a specific bioethical theory to assist patients and health care professionals evaluate the quality of life of the growing population of chronically ill adults with congenital heart disease.
Both Gillman's and Noah and Morgan's articles address approaching families with organ donation requests. Gillman provides the position of the major faith groups about organ donation, and Noah and Morgan provide an example of a multidisciplinary approach, guided by an algorithm.
Personal experiences with ethical dilemmas involving critically ill patients are discussed through case studies in the articles of Carlson, Ledbetter-Stone, and McLaughlin, Miller, and Wooten. The perspective dealt with in each article reflects the individual role of the authors (i.e., staff nurse, social worker, and case managers).
The articles by Lark and Gatti and Burt deal with the legal and ethical issues of health care providers ignoring an advanced directive that was written by a competent adult who is now terminally ill and unable to communicate. Once again, the individual articles reflect their own perspective as legal nurse consultants and a practicing attorney.
The advent of computerized medical records has evoked new ethical issues related to confidentiality and ownership. These are discussed in Veronesi's article.
Cogliano's article on medical futility considers the bioethical implications for the critical care nurse who all too often faces this problem.
An infrequent but troublesome practice of "slow code" is discussed in DePalma, Ozanich, Miller, and Yancich's interview of a physician and critical care nurse.
We would like to thank the editor of Critical Care Nursing Quarterly for recognizing the importance of ethical issues in practice and for giving us and the individual authors this opportunity for catharsis. In our own way of expressing our appreciation to each other as co-editors, we thought we would advise others as to how to choose a co-editor.
Key factors to look for in a co-editor:
* someone you can tolerate for countless hours,
* someone who can contribute a different focus on the work (for example, combine an idea person with a detail finisher),
* someone you feel comfortable showing your "dark side" at times, and finally
* someone who has a secretary and a sense of humor.
We were very fortunate in the way we were able to work together. It seemed that the week Evy was up, Judy was down, and vice versa. Between the two of us we found tactful ways of cajoling authors who were struggling to meet the deadlines. We actually became quite creative in some of our approaches, especially with the authors at our own organization. Maybe now they will no longer run the other way when they see us. We were able to honestly rant and rave and laugh and celebrate together.