Ethically Sound Care Starts Before the ICU: Nneka Sederstrom, PhD

As intensive care unit (ICU) admission is rarely planned, conversations about end-of-life wishes need to happen well before a crisis, according to Nneka Sederstrom, PhD, MPH, MA, a clinical ethicist and CEO of UzObi. At CHEST 2026 in Phoenix, Arizona, Sederstrom presented Beyond the Monitors, a panel on having the right conversations with vulnerable patients that brought together 3 CHEST groups focused on health equity, women, and LGBTQ+ issues.

Ethics as a Measure of Quality

ICU teams rarely have time to learn what a patient truly wants. Care often begins in an emergency, and families and caregivers frequently do not know the patient’s wishes. Sederstrom said goals-of-care conversations within the first 12 hours of admission would be ideal, but better still is for patients and families to arrive knowing the patient’s wishes, or at least their philosophy of care.

She tied that clarity to quality. “We can’t say that we’re doing high-quality care if it isn’t ethically sound.” Clinicians sometimes sense a decision is wrong for a patient but feel constrained by legal or risk concerns, which is when an ethics consultant should be part of the team from the start. “Call them in early. Call them in often.”

Sederstrom also argued that resource constraints are less about money than about health systems that are not designed to heal patients, calling for a closer look at patients’ needs.

Moving Conversations Upstream

To shift these discussions upstream, Sederstrom called for public education that anyone could end up in the ICU at any time. She said payers and others can help by making these conversations more accessible outside the hospital, so that primary care clinicians, specialists, and the ICU attending all know a patient’s wishes in advance. That preparation, she said, can make ICU care a smoother intervention and help ensure a patient’s philosophy of care is clearly followed when it matters most.