Strengths and Weaknesses of Substitute Decision Making in the ICU

  • A. Lautrette
  • E. Azoulay
  • B. Souweine


The doctor-patient relationship is at the heart of patient management. The trend in recent years has been towards patient autonomy. Frequently, intensive care unit (ICU) patients lack the capacity to make decisions about their health. In this case, surrogacy or substitute decision-making is one means of preserving patient autonomy. The legitimacy of surrogates is now widely recognized by physicians and many countries have passed legislation that offers the possibility of guaranteeing patient autonomy. Substitute decision-making involves three active participants: The patient, the surrogate, and the physician (with caregivers). For each of the three, substitute decision-making has both strengths and weaknesses.


Intensive Care Unit Patient Respir Crit Advance Directive Advance Care Planning Patient Autonomy 
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Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • A. Lautrette
    • 1
  • E. Azoulay
    • 2
  • B. Souweine
    • 1
  1. 1.Department of Nephrology and Medical Intensive CareCHU Gabriel MontpiedClermont-FerrandFrance
  2. 2.Department of Intensive CareHôpital Saint-LouisParisFrance

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