Responding to Surrogate Requests That Seem Inconsistent With a Patient’s Living Will

• Published in: Journal of pain and symptom management 2011-11, Vol.42 (5), p.777-782
• Main Authors: Vig, Elizabeth K., MD, MPH, Sudore, Rebecca L., MD, Berg, Karina M., MD, MS, Fromme, Erik K., MD, Arnold, Robert M., MD
• Format: Article
• Language: English
• Subjects: Advance Directive Adherence; Advance Directives; Aged, 80 and over; Anesthesia & Perioperative Care; Biological and medical sciences; Critical Care; Decision making; Evidence based; Female; Guidelines as Topic; Humans; Living wills; Living Wills - ethics; Medical sciences; Pain Medicine; Pharmacology. Drug treatments; Preferences; Stress; substituted judgment; Surrogates; Third-Party Consent - ethics
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2011.08.003

Abstract Clinicians may feel conflicted when a patient’s legal decision maker is making decisions that seem inconsistent with a patient’s living will. We provide evidence-based information to help clinicians consider whether a surrogate’s inconsistent decisions are ethically appropriate. Surrogates are not flawless translators of their loved one’s preferences; they are influenced by their own hopes and the current clinical context. Patients may be aware of this, are often concerned about burdening their loved ones, and often grant their surrogates leeway in interpreting their wishes. When appropriate, clinicians should respect surrogates’ interpretations of patient values and take steps to decrease surrogate stress during the decision-making process. Finally, if clinicians are cognizant of their own values and preferences, they may recognize how these may affect their responses to certain clinical cases.