During the 20th century, medical decision making shifted from a paternalistic approach to an autonomy-based standard in the United States. Now, in the 21st century, the pendulum is swinging back and the medical community and the public are increasingly embracing shared decision making. In many other parts of the world paternalism remained the primary approach, yet there is now a move toward shared decision making occurring internationally. This “meeting in the middle” has been spurred by the 2004 endorsement of shared decision making over either strict autonomy or physician-directed decision making by the leading critical care organizations in Europe and the United States.1 Furthermore, the American Medical Association, the American College of Critical Care, and the American Academy of Pediatrics all advocate shared decision making.2- 4
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