Encouraging dialogue and autonomy in the burn intensive care unit.

Developing a systematic, rigorous approach to one major ethical issue--autonomous decision making by patients--as part of a standardized burn protocol ensures that the ill and injured persons we care for are given respect and a sense of control over their destiny. We cannot document a clinical, physiologic benefit to this particular approach but do find that early, frank discussions with patients, when combined with careful, active listening, help form strong care-giver-patient bonds. The patient's designation of a spokesperson to be consulted if the patient becomes unable to speak for himself prevents a great deal of anguish should the patient become comatose. The patient's wishes concerning limitations, if any, of maximal treatment are noted and respected. We believe that our approach is legally and ethically sound and can serve as one model for establishing informed consent in an intensive care setting.