Bioethics Blogs

Shared Decision Making in ICUs

Lead author Alex Kon

The American College of Critical Care Medicine and American Thoracic Society have issued a new policy statement on shared decision making in ICUs.

They endorse six recommendations: 

  1. Shared decision making is a collaborative process that allows patients, or their surrogates, and clinicians to make healthcare decisions together, taking into account the best scientific evidence available, as well as the patient’s values, goals, and preferences.  
  2. Clinicians should engage in a shared decision making process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences.
  3. Clinicians should use as their “default” approach a shared decision making process that includes three main elements: information exchange, deliberation, and making a treatment decision. 
  4. A wide range of decision-making approaches are ethically supportable, including patient- or surrogate-directed and clinician-directed models. Clinicians should tailor the decisionmaking process based on the preferences of the patient or surrogate. 
  5. Clinicians should be trained in communication skills. 
  6. Research is needed to evaluate decision-making strategies.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.