Patient autonomy versus parentalism.

Several decision-making models have been advanced to characterize the patient-physician relationship. These include the parental model, the informed decision-making model, the interpretive model, and the deliberative model. Although these models are useful to consider in reflecting on the care we give to critically ill patients at the end of life, they require adaptation to the intensive care unit (ICU). Many clinicians adapt their approach to each individual patient and change their approach to the same patient over time. Moreover, instead of the dyadic model of one patient and one physician, multiple voices often speak for the patient and a team of clinicians care for the ICU patient. Analysis of human relationships and communication with critically ill patients and their families require transdisciplinary, multicultural, and multidisciplinary interpretation.