Strengths and Weaknesses of Substitute Decision Making in the ICU
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.
KeywordsIntensive Care Unit Patient Respir Crit Advance Directive Advance Care Planning Patient Autonomy
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- 4.Teno J, Lynn J, Wenger N, Phillips RS, et al (1997) Advance directives for seriously ill hospitalized patients: effectiveness with the patient self-determination act and the SUPPORT intervention. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Am Geriatr Soc 45: 500–507PubMedGoogle Scholar
- 10.Puchalski CM, Zhong Z, Jacobs MM, et al (2000) Patients who want their family and physician to make resuscitation decisions for them: observations from SUPPORT and HELP. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. Hospitalized Elderly Longitudinal Project. J Am Geriatr Soc 48:S84–90Google Scholar
- 37.French Senate (2004) Patients rights at the end-of-life in European countries. Comparative Law Study n°139, November 2004. Available at: http://www.senat.fr/lc/lc139/lc1390.html Accessed Nov 2008Google Scholar
- 38.French Public Health Code, law of 4 March 2002 on Patients Rights, article: L1111. Available at: http://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000000227015&dateTexte =Accessed Nov 2008Google Scholar