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End-of-Life Communication in the ICU: A Global Perspective

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The world is composed of multiple, diverse populations of different race, culture, and religion. Increasingly, these populations are mixing and intermingling, both physically with faster and cheaper air travel, and mentally via communication systems, including the Internet. Knowledge of other countries, cultures, and continents can enrich society, but can also harbor conflict and tension as different peoples struggle to understand each other without losing their own identity. In 1962, Marshall McLuhan already envisaged that new electronic interdependence would recreate the world in the image of a global village.1 The intensive care “fraternity” is little different. Intensive care medicine has grown immensely since the early days following the polio epidemics in the 1960s, but has developed in a somewhat haphazard manner until relatively recently, when some attempt at uniformity of training has emerged at the national and international level. Intensive care doctors (intensivists) also come from different cultures and have different religious beliefs and backgrounds and different academic and specialty experience. Intensive care medicine is, therefore, practiced differently in different countries and even in different institutions within the same country depending on broad differences in local culture and custom, but also on the individual doctors manning the unit.

But although we may have different approaches and attitudes to the way in which we practice intensive care medicine, which can result in heated debate and disagreement, our ultimate aim is the same: to treat the critically ill patient to the best of our ability within the limitations of available equipment and facilities. Over recent years, with the development and availability of electronic mass media, intensivists are increasingly seeing themselves as part of a bigger picture, part of a global network of physicians, a global village within the wider medical world, where sharing information, data, and practices across national and international boundaries can provide benefit for us and also for our patients.
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