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The Theory and Practice of Surrogate Decision‐Making
Author(s) -
Wendler David
Publication year - 2017
Publication title -
hastings center report
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.515
H-Index - 63
eISSN - 1552-146X
pISSN - 0093-0334
DOI - 10.1002/hast.671
Subject(s) - directive , autonomy , psychology , process (computing) , medical decision making , next of kin , decision making , social psychology , clinical decision making , medicine , computer science , law , medical emergency , political science , family medicine , operations management , purchasing , economics , programming language , operating system
Abstract When a patient lacks decision‐making capacity and has not left a clear advance directive, there is now widespread agreement that patient‐designated and next‐of‐kin surrogates should implement substituted judgment within a process of shared decision‐making. Specifically, after discussing the “best scientific evidence available, as well as the patient's values, goals, and preferences” with the patient's clinicians, the patient‐designated or next‐of‐kin surrogate should attempt to determine what decision the patient would have made in the circumstances. To the extent that this approach works, it seems to provide about as much respect for the autonomy of incapacitated patients as we could ask for. But, as articles in this issue of the Report by Jeffrey Berger and by Ellen Robinson and colleagues emphasize, reality presents challenges.