title: Medical decision making: paternalism versus patient-centered (autonomous) care.
abstract: OBJECTIVE
  Medical literature has increasingly emphasized the need to observe patients' autonomy; however, not all experts agree with this principle. This discord is based on varying credence between the concepts of autonomy and beneficence. In critically ill patients, this conflict involves the patient's family and creates a particular family-physician relationship. The purpose of this review is to assess the evidence on medical decision making and the family-physician relationship.
  
  
  RESULTS
  The many studies published on this topic reveal that people's preferences around the medical decision-making process vary substantially. Although it is clear that a shared decision approach is popular and desirable to some, it is not universally favored; some patients prefer to leave final treatment decisions up to the doctor. This finding shows a robust moral pluralism, which requires special attention in multicultural societies. For critically ill patients, the diversity of opinion extends to the family, which creates a complex family-physician dynamic and necessitates utilization of particular interaction strategies.
  
  
  CONCLUSIONS
  Clinicians must understand the range of preferences in a society and should offer the opportunity to participate in treatment by sharing decision-making responsibility. This would involve assessing the preferences of patients and their families in order to provide care accordingly. Clinicians should then ensure proper information is provided for informed decision making and minimize factors that could have potential adverse effect.
authors.affiliation: Department of Critical Care Medicine, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Rodriguez-Osorio
authors.forename: Guillermo
authors.initials: G
authors.lastname: Dominguez-Cherit
mesh_terms: D016638:Critical Illness; D003657:Decision Making / Q000941:ethics*; D026690:Ethics, Clinical; D004992:Ethics, Medical; D006801:Humans; D026706:Paternalism / Q000941:ethics*; D018802:Patient-Centered Care / Q000941:ethics*; D026684:Personal Autonomy; D010817:Physician-Patient Relations / Q000941:ethics*; D011368:Professional-Family Relations / Q000941:ethics*