New perspectives on substituted relational autonomy for shared decision-making in critical care

Nicola Grignoli,Roberto Malacrida,Valentina Di Bernardo

doi:10.1186/s13054-018-2187-6

Abstract

In critical care when unconscious patients are assisted by machines, humanity is mainly ensured by respect for autonomy, realised through advance directives or, mostly, reconstructed by cooperation with relatives. Whereas patient-centred approaches are widely discussed and fostered, managing communication in complex, especially end-of-life, situations in open intensive care units is still a point of debate and a possible source of conflict and moral distress. In particular, healthcare teams are often sceptical about the growing role of families in shared decision-making and their ability to represent patients’ preferences. New perspectives on substituted relational autonomy are needed for overcoming this climate of suspicion and are discussed through recent literature in the field of medical ethics.

Highlights

In critical care when unconscious patients are assisted by machines, humanity is mainly ensured by respect for autonomy, realised through advance directives or, mostly, reconstructed by cooperation with relatives
Its application has long been a topic of debate in bioethics [2] and has been a focus of recent discussions related to the need for shared decision-making (SDM) in critical care [3,4,5]
Relational models of autonomy inspired by phenomenology and feminist perspectives [16, 17] answer the current need to reconstruct preferences through comparing and integrating different opinions: from this point of view deliberation is not purely selfish but is shared, responding to the characteristics that future generations will bring to critical care

Summary

Introduction

In critical care when unconscious patients are assisted by machines, humanity is mainly ensured by respect for autonomy, realised through advance directives or, mostly, reconstructed by cooperation with relatives. Its application has long been a topic of debate in bioethics [2] and has been a focus of recent discussions related to the need for shared decision-making (SDM) in critical care [3,4,5].

Results

Conclusion