Context and background
Autonomy in critical state
Seize the challenge of SDM
Challenges | Solutions |
---|---|
• Balancing ethical responsibilities in SDM | • Cooperation • Relational autonomy |
• Preventing burnout | • Consultant psychologist |
• Preventing moral distress | • Ethical advice |
• Managing interpersonal conflicts in end-of-life SDM | • Interdisciplinary meetings • Staff management and dispositional organization |
• Providing valuable information | • Structured communication tools |
• Preventing relatives’ psychological disorders | • Physician's social, psychological and ethical skills • Training |
• Embedded accuracy of the relatives’ predictions | • Offering support to relatives |
“Open” ICUs: still on the way
Difficulties | Opportunities |
---|---|
• Understanding medical information ○ Appreciating consequences ○ Relevance accorded to technical and clinical information ○ Emotional context | • Involvement in regular meetings ○ Collect and trace relevant data on the basis of clinical changes ○ Prevent and detect misunderstandings ○ Benefit from regular and effective communication |
• Assuming moral responsibility for the wishes of the patient ○ Defining relatives’ personal values and priorities ○ Defining power of attorney (conflicts within relatives) | • Provide patient’s personal information ○ Perceived health-related quality of life ○ Character and will to live (demonstrated resilience) ○ History of illness |
• Low accuracy in predicting patient’s preferences • Disagreements about goals of care (especially in end-of-life situations) | • Share responsibilities ○ Possibility to engage with the interdisciplinary team ○ Possibility to check other sources of information (web, social media) |
• Exposure to emotional burden and psychological disorders | • Maintain and share intimacy with patient |
“Substituted relational autonomy”
Traditional model | Relational model |
---|---|
• Freedom of choice | • Freedom of choice |
• Primacy of informed consent | • Role and influence of others on expanding individual’s ability to make choices |
• Voluntariness • Independence • Self-sufficiency | • Consider influence of relatives that is wanted and expected by some patients |
• Maintenance of control over situations | • Health and sickness viewed also as interpersonal and family events |
• Ability to exercise proper responsibility | • Role of social relationships in developing individual’s identity |
• Avoidance of interference and undue pressures | • Adapt individual preferences to the needs of loved ones |
• Clear boundaries between self and others | • Importance of personal relationships and shared interests |