"While the wolf is away": the echo of globalization delaying family decisions in intensive care - Critical Care Science (CCS)

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“While the wolf is away”: the echo of globalization delaying family decisions in intensive care

Globalization is a complex process that is defined as the “shrinking” of our world through advances in technology and industry; specifically, individuals, peoples, and nations that are very distant from each other are now in contact and may share at least some aspects of a “global” culture.() Globalization is multifaceted by nature, affecting society economically, socially, and culturally.() Consequently, globalization also impacts health care and medicine. Increases in migration cause individuals and families to be scattered across diverse locations.() Career opportunities, academic pursuits, and personal preferences frequently motivate individuals to move away from their family. Concurrently, there is a clear trend toward the aging of the world’s population.() The combination of these two phenomena results in complex dynamics between family members who migrate (and who may or may not return, even if only temporarily) and those who stay.()

Studies on the care of older individuals from a migration perspective are still lacking.() One specific aspect of migration that merits attention is its impact on decision-making in critical scenarios. When a parent or other close family member becomes severely ill, swift and well-informed decisions about their treatment are necessary. However, globalization-induced physical separation has the potential to slow the decision-making process, given that family members often reside in different time zones or even on different continents, obstructing communication and coordination. The intricacy of health care choices in the intensive care unit cannot be minimized. Families must discuss matters related to life-preserving treatments, palliative care, and quality of life. These decisions, which are intrinsically difficult, become even more difficult in families separated by migration. In the case of elderly people who remain in their home country, the younger generation that has migrated may be called upon to participate or even lead these discussions and often must deal with feelings of guilt and internal and intrafamilial conflicts.()

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