Des préférences des malades à la décision médicale

The opinion of the patient for the made of a medical decision in intensive care has to be considered in the following circumstances: the admittance in the intensive care unit, the realization of investigations and treatments and possibly the withholding and/or withdrawal of life support. The patient can express his preferences for the made of a medical decision only if he is competent. The competence of a patient admitted in the intensive care unit can be estimated by making sure that he understands the problems posed by his disease by asking him to paraphrase the information, which were given to him. When an incompetent person is unable to express its will, his preferences for the made of a medical decision can be expressed by a surrogate. The physician can decide on its place and he informs the family about it. With patients in advanced or terminal phase of a serious and incurable disorder, the physician can decide to limit or to stop a useless treatment having respected the collective procedure and having consulted a surrogate. It is desirable that the decision-making is shared between the team of care and the family. The success of this procedure rests on a good quality communication between the concerned persons. The met difficulties can be due to a refusal to participate of the family, in cultural and religious differences or variety of opinion within the family or within the team of care. A situation of conflict can exist, when the family asks for the continuation of treatments against the opinion of the medical team. Most of the conflicts can be resolved if the protagonists try of understand and respect themselves mutually.