Intensive Care Medicine

, Volume 44, Issue 10, pp 1628–1637 | Cite as

Competing and conflicting interests in the care of critically ill patients

  • Alison E. TurnbullEmail author
  • Sarina K. Sahetya
  • E. Lee Daugherty Biddison
  • Christiane S. Hartog
  • Gordon D. Rubenfeld
  • Dominique D. Benoit
  • Bertrand Guidet
  • Rik T. Gerritsen
  • Mark R. Tonelli
  • J. Randall Curtis


Medical professionals are expected to prioritize patient interests, and most patients trust physicians to act in their best interest. However, a single patient is never a physician’s sole concern. The competing interests of other patients, clinicians, family members, hospital administrators, regulators, insurers, and trainees are omnipresent. While prioritizing patient interests is always a struggle, it is especially challenging and important in the ICU setting where most patients lack the ability to advocate for themselves or seek alternative sources of care. This review explores factors that increase the risk, or the perception, that an ICU physician will reason, recommend, or act in a way that is not in their patient’s best interest and discusses steps that could help minimize the impact of these factors on patient care.


Critical care Patient-centered care Research design Clinical studies as topic Conflict of interest 



The authors wish to thank Medical Librarian Carrie Price, MLS, for her assistance.

Compliance with ethical standards

Conflicts of interest

The authors declare that no conflict of interest exists.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Alison E. Turnbull
    • 1
    • 2
    • 3
    Email author
  • Sarina K. Sahetya
    • 1
  • E. Lee Daugherty Biddison
    • 1
  • Christiane S. Hartog
    • 4
    • 5
    • 6
  • Gordon D. Rubenfeld
    • 7
    • 8
  • Dominique D. Benoit
    • 9
  • Bertrand Guidet
    • 10
    • 11
    • 12
  • Rik T. Gerritsen
    • 13
  • Mark R. Tonelli
    • 14
    • 15
  • J. Randall Curtis
    • 15
    • 16
  1. 1.Division of Pulmonary and Critical Care Medicine, School of MedicineJohns Hopkins UniversityBaltimoreUSA
  2. 2.Department of Epidemiology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreUSA
  3. 3.Outcomes After Critical Illness and Surgery (OACIS) GroupJohns Hopkins UniversityBaltimoreUSA
  4. 4.Department for Anesthesiology and Intensive CareJena University HospitalJenaGermany
  5. 5.Department of Anaesthesiology and Operative Intensive Care MedicineCharité Universitätsmedizin BerlinKreischaGermany
  6. 6.Patient- and Family-Centered CareKlinik BavariaKreischaGermany
  7. 7.Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
  8. 8.Department of Critical Care MedicineSunnybrook Health Sciences CentreTorontoCanada
  9. 9.Intensive Care UnitGhent University HospitalGhentBelgium
  10. 10.Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Réanimation MédicaleParisFrance
  11. 11.Sorbonne Universités, Université Pierre et Marie CurieParisFrance
  12. 12.Institut National de la Santé et de la Recherche Médicale (INSERM), UMR S 1136, Institut Pierre Louis d’Épidémiologie et de Santé PubliqueParisFrance
  13. 13.Department of Intensive CareMedisch Centrum LeeuwardenLeeuwardenThe Netherlands
  14. 14.Department of Bioethics and HumanitiesUniversity of WashingtonSeattleUSA
  15. 15.Division of Pulmonary, Critical Care, and Sleep MedicineUniversity of WashingtonSeattleUSA
  16. 16.Cambia Palliative Care Center of ExcellenceUniversity of WashingtonSeattleUSA

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