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Updated: Feb 4, 2026

Perspectives on Neuroscience
Published on: July 31, 2007
New perspectives on substituted relational autonomy for shared decision-making in critical care
Nicola Grignoli1,2,3, Valentina Di Bernardo4,5,6, Roberto Malacrida4
1Sasso Corbaro Medical Humanities Foundation, Via Lugano 4b, CH-6500, Bellinzona, Switzerland. nicola.grignoli@eoc.ch.
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.
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