Who Knows the Patient Best? An Epistemological Approach to Family-Centered Care for Unconscious Patients in the Adult...

The adult intensive care unit is a complex, high-acuity environment where critically ill patients frequently cannot communicate their needs, values, or preferences due to altered consciousness, sedation, or neurological impairment. This Discussion paper develops an epistemological framework for family-centered care in adult intensive care units, emphasizing the integration of diverse knowledge forms, empirical, personal, ethical, aesthetic, and emancipatory into clinical decision-making for unconscious patients. It highlights families as essential epistemic authorities who provide unique insights into patients' values, preferences, and identities, complementing biomedical knowledge. The framework addresses epistemic injustices that marginalize family knowledge, advocating for culturally sensitive, collaborative approaches that fuse clinical expertise with familial narratives. Practical strategies such as structured communication protocols and narrative integration are discussed to enhance family involvement. The discussion paper underscores epistemic humility, recognizing the limits of both clinical and family knowledge in the face of prognostic uncertainty. By promoting dialogue and shared understanding, this pluralistic approach aims to improve ethical clarity and patient-centered outcomes in ICU care, fostering a partnership model where families and clinicians co-construct meaning and care decisions.