Ethical Decision-Making in Intensive Care Units and Hospital Ethics Committees

Patient-centered decision-making, which in the United States and the west is typically considered to be appropriate, may not be universally endorsed, thereby harboring the potential to complicate the care of patients from other cultural backgrounds in potentially unrecognized ways. A primary determinant of the nature of communication in health care is the conception that the participants have of the individual. Western bioethics now focuses more on ethical decisions that are based on individual autonomy, while the social framework of decision-making has diminished in significance. This individualistic model of medical decision-making, the so-called “autonomy paradigm”, has achieved dominance in the United States over the “social framework paradigm”, which plays a greater role in other countries. In placing patient autonomy at the center of ethical decisions, the medical community in the United States has proceeded as if this were universally appropriate. However, other countries have not experienced this recent paradigm shift, and physician-patient communication is consequently quite different. Thus, different societies have developed different models for communication, reflecting the unique socio-cultural, legal, educational, and economical circumstances. In our view, this does not indicate that the basic ethical principles are not universal. In the Turkish culture, for example, these principles are not at odds with those of the west. We believe that the difference lies in the priority and weight given to each of those principles, like patient rights, wishes of the family and interests of the society as a whole. Even within the same culture, one rigid model may not suit all patients and relatives, and a great degree of flexibility and skill need to be exercised by the practicing physician. Effective physician-patient communication is far more complex than simply giving information. Many authors in the field of Medical Ethics have formulated new concepts when it comes to dealing with those principles. The ...