How clinicians can respond when family members question a proxy/surrogate's judgment and decisional capacity

Author:

Calon Gregoire1,Drabiak Katherine2ORCID

Affiliation:

1. Morsani College of Medicine, University of South Florida, Tampa, Florida, USA

2. College of Public Health, University of South Florida, Tampa, Florida, USA

Abstract

Many state laws specify procedures for determining surrogate or proxy decision-makers for end-of-life care in the absence of an advance directive, living will, or other designation. Some laws also set forth criteria that the decision-maker must follow when making medical decisions for an incapacitated patient and determining whether to withdraw life-sustaining treatment. This article provides analysis of a medical ethics case on the question of how to address family allegations that the proxy decision-maker suffers from dementia and is unable to make decisions for the patient. Cases such as this involve interwoven legal and ethical considerations including: how to address concerns that the proxy is making questionable or unreasonable decisions, how to evaluate the proxy's decisional capacity, strategies for enhancing communication, and standards for removing a proxy. This article suggests that “surrogacy ladders” in state law serve not only as a procedural mechanism, but also protect important ethical values such as tiers of moral authority for decision-making, relational autonomy, and privacy.

Publisher

SAGE Publications

Subject

Philosophy,Issues, ethics and legal aspects,Medicine (miscellaneous)

Reference34 articles.

1. American Bar Association Commission on Law and Aging. Default Surrogate Consent Statutes. American Bar Assocation. 2022. https://www.americanbar.org/content/dam/aba/administrative/law_aging/2019-sept-default-surrogate-consent-statutes.pdf.

2. A history of resolving conflicts over end-of-life care in intensive care units in the United States*

3. The Effect of Statutory Limitations on the Authority of Substitute Decision Makers on the Care of Patients in the Intensive Care Unit

4. Legal Fundamentals of Surrogate Decision Making

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