[A review of bioethics in the Intensive Care Unit: The autonomy and role of relatives and legal representatives]

Abstract

In recent decades we have witnessed a change in mentality in which patient autonomy has reached significant preponderance, with informed consent as the prime example. The approach in situations where the patient cannot make decisions varies from one country to another, affording greater or lesser importance to the wishes of the family when a surrogate has not been designated. Several studies show discrepancies between the decisions of patients and that the decisions which their surrogates have taken for them. We review concepts such as greatest benefit, evaluate the potential limitations of advance care directives, and consider different options when the action or treatment proposed by professionals comes into conflict with the ideas expressed by the patient's family or surrogates, and which has led to different legally sanctioned solutions in some regions.

Keywords: Advance care directives; Bioethics; Bioética; Estado vegetativo permanente; Futility; Instrucciones previas; Inutilidad; Limitación de las técnicas de soporte vital; Limitation of life support; Persistent vegetative state; Representante; Surrogate.