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Advances in Hematology
Volume 2014, Article ID 704318, 8 pages
Review Article

Ethical and Clinical Aspects of Intensive Care Unit Admission in Patients with Hematological Malignancies: Guidelines of the Ethics Commission of the French Society of Hematology

1Hematology Department of the René Huguenin Hospital, Institut Curie, 35 rue Dailly, 92210 Saint-Cloud, France
2Ethics Commission of the French Society of Hematology, France
3Hematology Department of the University of Grenoble, 38043 Grenoble, France
4Hematology Department of the Robert Boulin Hospital, 33505 Libourne, France
5Hematology Department of the University of Tours, 37044 Tours, France
6Hematology Department of the University of Bobigny, 93000 Bobigny, France
7Hematology Department of the University of Saint-Antoine, 75012 Paris, France
8Hematology Department of the University of Créteil, 94010 Créteil, France
9Hematology Department of the University of Necker, 75015 Paris, France
10Hematology Department of the University of Besançon, 25030 Besançon, France
11Hematology Department of the Hôtel-Dieu Hospital, 75001 Paris, France
12Hematology Department of the University of Limoges, 87042 Limoges, France

Received 29 July 2014; Revised 22 September 2014; Accepted 22 September 2014; Published 1 October 2014

Academic Editor: Emili Montserrat

Copyright © 2014 Sandra Malak et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Admission of patients with hematological malignancies to intensive care unit (ICU) raises recurrent ethical issues for both hematological and intensivist teams. The decision of transfer to ICU has major consequences for end of life care for patients and their relatives. It also impacts organizational human and economic aspects for the ICU and global health policy. In light of the recent advances in hematology and critical care medicine, a wide multidisciplinary debate has been conducted resulting in guidelines approved by consensus by both disciplines. The main aspects developed were (i) clarification of the clinical situations that could lead to a transfer to ICU taking into account the severity criteria of both hematological malignancy and clinical distress, (ii) understanding the process of decision-making in a context of regular interdisciplinary concertation involving the patient and his relatives, (iii) organization of a collegial concertation at the time of the initial decision of transfer to ICU and throughout and beyond the stay in ICU. The aim of this work is to propose suggestions to strengthen the collaboration between the different teams involved, to facilitate the daily decision-making process, and to allow improvement of clinical practice.