What Should Physicians Do When They Disagree, Clinically and Ethically, with a Surrogate's Wishes?

Area of Science:

• Medical Ethics
• Clinical Communication
• Bioethics

Background:

• Disagreements between physicians and surrogate decision-makers regarding intensive care unit (ICU) treatment are common.
• Surrogates' demands for aggressive treatment can cause moral distress for physicians.
• Effective communication strategies are needed to navigate these complex ethical situations.

Purpose of the Study:

• To identify virtues and communication strategies for physicians responding to surrogate disagreements in ICUs.
• To provide a framework for facilitating common ground and alleviating physician moral distress.
• To enhance ethical decision-making in critical care settings.

Main Methods:

• Conceptual analysis of ethical principles and communication theories.
• Review of literature on moral distress and surrogate decision-making.
• Development of a framework based on moral community.

Main Results:

• Physicians can experience moral distress when surrogates' treatment preferences conflict with their clinical judgment.
• Specific virtues such as empathy, honesty, and respect are crucial for effective communication.
• A framework emphasizing shared moral community can help bridge divides and reduce distress.

Conclusions:

• Effective communication strategies and virtues are essential for physicians managing surrogate disagreements in ICUs.
• Building a shared moral community can foster understanding and alleviate moral distress.
• This approach supports ethical care and improves the physician-surrogate relationship in critical care.