Burned Beyond Recognition: Ethics of Care

Several ethical issues arise in the care of acutely burned patients. These include medical decision-making, patient autonomy, informed consent, decisional capacity, and the patient-provider relationship. In the of case of severe or catastrophic burn injury, additional ethical concerns often develop that require consideration, such as surrogate decision-making, medical futility, withholding and withdrawing of treatment, and end of life care. Various approaches have been advocated as a strategy to manage the ethical challenges of burn care including moral principlism, which highlights the moral principles of beneficence, nonmaleficence, respect for patient autonomy, and distributive justice. An alternative strategy with clinical applicability is the “four-quadrant” approach, in which medical indications, patient preferences, quality-of-life, and contextual features are used to guide care. Regardless of the system employed, providers would benefit from a rational understanding of the ethical issues that frequently arise during the management of burn patients. Indeed, attentive application of clinical ethics in such cases often serves to facilitate the provision of optimal medical care while simultaneously ensuring the utmost respect for patient autonomy. This chapter will highlight ethical issues that arise in care of burn patients. Additionally, moral foundations, clinical considerations, and special cases will be discussed. Finally, an overview of various frameworks for addressing ethical challenges in burn care will be provided.