The Ethics of Critical Care in Cross-Cultural Perspective

Abstract

The preliminary documents of the conference for which this paper was prepared outlined two primary clusters of ethical issues in critical medical choices. One cluster centered on problems of “autonomy and paternalism.” Insofar as the principle of autonomy is seen as implying liberty rights, that is, the right of self-determination, the right to be let alone, the primary significance for critical care decision-making has been the assertion of the right to refuse such care. The critical care questions in the American debate have been: How can the rational individual express his autonomy by deciding to escape the assault of aggressive but agonizing tinkering by medical professionals desperately trying to overpower nature when the patient would prefer to step back and let nature take its course? How can we decide who really is a rational, autonomous individual? And how can we find autonomous surrogates to make decisions for those who are not competent?