How is caring paternalism feasible in the intensive care unit? - an ethnographic study

The intensive care unit (ICU) is characterized by critically ill patients and strict medical management, which has fostered a model of medical paternalism. Although these practices are often justified to protect patients' "best interests," they frequently neglect individuals' emotional needs and autonomy. The ethics of care is an ethical framework that emphasizes relationality, empathy, and responsiveness to patients' lived experiences. Unlike traditional risk-centered medical models, it focuses on the patient's authentic needs within their specific context. This study analyzes ICU paternalism through the lens of the ethics of care, exploring how compassionate, patient-centered strategies can be integrated with clinical safety to balance risk management with individualized care.

An ethnographic approach was employed from September 2022 to April 2023 in the ICU of a large general hospital in China. Data were collected through participant observation and both semi-structured and informal interviews with healthcare professionals and patients. A total of 23 participants were interviewed, including 9 physicians, 6 nurses, and 8 patients. Data were analyzed using thematic content analysis, guided by a theoretical framework rooted in the ethics of care.

The study revealed that medical paternalism in the ICU manifested in diverse, interconnected ways, including strict restrictions on personal belongings, the implementation of restricted visitation policies, and limitations on patients' ability to participate in decision-making or express their needs. These practices not only led to patients' emotional isolation and diminished autonomy but also exposed a profound structural tension between paternalistic management approaches and patient-centered care principles within the ICU setting.

While medical paternalism in the ICU may be justified for clinical safety, its traditional approach inadequately addresses patients' psychological and emotional needs. From the perspective of the ethics of care, the study advocates for integrating compassionate, individualized care strategies into clinical interventions to create an ICU model that is both scientifically robust and humane.

Not applicable. This study does not involve a healthcare intervention or a clinical trial.