Clearly these situations are quite
different from the classic examples
of the informed consent process,
where a conscious patient carefully
deliberates (after risks, benefits, and
alternatives are disclosed) an isolated
surgical procedure or a course of
chemotherapy. Due to the effects of
illness and the sedative and analgesic
agents required to implement LSTs
(Hofsø & Coyer, 2007), many ICU
patients are not sufficiently conscious
or decisionally capable to participate
in discussions about treatment
or are only able to participate
to a limited extent. In these instances,
there is a heavy reliance on decisional
surrogates. Admittedly, the process
of informed consent in these settings
is difficult; however, the obligation
to determine and honor individual
values and preferences remains