Food and Drug Administration –

Food and Drug Administration


Food and Drug Administration

Employing a clinician-directed decision-making model requires great care. The clinician should ensure that the surrogate’s preference for such a model is not based on inadequate information, insufficient support from clinicians, or other remediable causes. Further, when the surrogate prefers to defer a specific decision to the clinician, the clinician should not assume that all subsequent decisions are also deferred. The surrogate should therefore understand what specific choice is at hand and should be given as much (or as little) information as the surrogate wishes.

The full policy statement provides significant guidance and examples in these areas (6).

Finally, ACCM and ATS recommend further research to assess the use of various approaches to decision-making in the ICU. The use of decision aids, communication skills training, implementation of patient navigator or decision support counselor programs, and other interventions should be subjected to randomized controlled trials to assess efficacy. Considerations regarding the cost and time burdens should be weighed against

anticipated benefits from such interventions when determining which efforts to implement. n

Author disclosures are available with the text of this article at

Acknowledgment: The views expressed in this article represent the official position of the American College of Critical Care Medicine, the Society of Critical Care Medicine, and the American Thoracic Society. These views do not necessarily reflect the official policy or position of the U.S. Department of the Navy, U.S. Department of Defense, U.S. National Institutes of Health, U.S. Department of Veterans Affairs, U.S. Food and Drug Administration, or U.S. Government.

Alexander A. Kon, M.D. Naval Medical Center San Diego San Diego, California


University of California San Diego San Diego, California

Judy E. Davidson, D.N.P., R.N. University of California Health System San Diego, California

Wynne Morrison, M.D. Children’s Hospital of Philadelphia Philadelphia, Pennsylvania

Marion Danis, M.D. National Institutes of Health Bethesda, Maryland

Douglas B. White, M.D., M.A.S. University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania


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