SherbyNet - /page/wikibook/entry.mu

Micron Document

<!DOCTYPE html>

<title>Surrogate decision-maker</title>

</head>

Surrogate decision-maker

</h1>

</header>

/* start https://en.wikipedia.org/ */

.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}

/* end https://en.wikipedia.org/ */

</style>

/* start https://en.wikipedia.org/ */

.mw-parser-output .hlist dl,.mw-parser-output .hlist ol,.mw-parser-output .hlist ul{margin:0;padding:0}.mw-parser-output .hlist dd,.mw-parser-output .hlist dt,.mw-parser-output .hlist li{margin:0;display:inline}.mw-parser-output .hlist.inline,.mw-parser-output .hlist.inline dl,.mw-parser-output .hlist.inline ol,.mw-parser-output .hlist.inline ul,.mw-parser-output .hlist dl dl,.mw-parser-output .hlist dl ol,.mw-parser-output .hlist dl ul,.mw-parser-output .hlist ol dl,.mw-parser-output .hlist ol ol,.mw-parser-output .hlist ol ul,.mw-parser-output .hlist ul dl,.mw-parser-output .hlist ul ol,.mw-parser-output .hlist ul ul{display:inline}.mw-parser-output .hlist .mw-empty-li{display:none}.mw-parser-output .hlist dt::after{content:": "}.mw-parser-output .hlist dd::after,.mw-parser-output .hlist li::after{content:" · ";font-weight:bold}.mw-parser-output .hlist dd:last-child::after,.mw-parser-output .hlist dt:last-child::after,.mw-parser-output .hlist li:last-child::after{content:none}.mw-parser-output .hlist dd dd:first-child::before,.mw-parser-output .hlist dd dt:first-child::before,.mw-parser-output .hlist dd li:first-child::before,.mw-parser-output .hlist dt dd:first-child::before,.mw-parser-output .hlist dt dt:first-child::before,.mw-parser-output .hlist dt li:first-child::before,.mw-parser-output .hlist li dd:first-child::before,.mw-parser-output .hlist li dt:first-child::before,.mw-parser-output .hlist li li:first-child::before{content:" (";font-weight:normal}.mw-parser-output .hlist dd dd:last-child::after,.mw-parser-output .hlist dd dt:last-child::after,.mw-parser-output .hlist dd li:last-child::after,.mw-parser-output .hlist dt dd:last-child::after,.mw-parser-output .hlist dt dt:last-child::after,.mw-parser-output .hlist dt li:last-child::after,.mw-parser-output .hlist li dd:last-child::after,.mw-parser-output .hlist li dt:last-child::after,.mw-parser-output .hlist li li:last-child::after{content:")";font-weight:normal}.mw-parser-output .hlist ol{counter-reset:listitem}.mw-parser-output .hlist ol>li{counter-increment:listitem}.mw-parser-output .hlist ol>li::before{content:" "counter(listitem)"\a0 "}.mw-parser-output .hlist dd ol>li:first-child::before,.mw-parser-output .hlist dt ol>li:first-child::before,.mw-parser-output .hlist li ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}

/* end https://en.wikipedia.org/ */

</style><style data-mw-deduplicate="TemplateStyles:r1246091330">

/* start https://en.wikipedia.org/ */

.mw-parser-output .sidebar{width:22em;float:right;clear:right;margin:0.5em 0 1em 1em;background:var(--background-color-neutral-subtle,#f8f9fa);border:1px solid var(--border-color-base,#a2a9b1);padding:0.2em;text-align:center;line-height:1.4em;font-size:88%;border-collapse:collapse;display:table}body.skin-minerva .mw-parser-output .sidebar{display:table!important;float:right!important;margin:0.5em 0 1em 1em!important}.mw-parser-output .sidebar-subgroup{width:100%;margin:0;border-spacing:0}.mw-parser-output .sidebar-left{float:left;clear:left;margin:0.5em 1em 1em 0}.mw-parser-output .sidebar-none{float:none;clear:both;margin:0.5em 1em 1em 0}.mw-parser-output .sidebar-outer-title{padding:0 0.4em 0.2em;font-size:125%;line-height:1.2em;font-weight:bold}.mw-parser-output .sidebar-top-image{padding:0.4em}.mw-parser-output .sidebar-top-caption,.mw-parser-output .sidebar-pretitle-with-top-image,.mw-parser-output .sidebar-caption{padding:0.2em 0.4em 0;line-height:1.2em}.mw-parser-output .sidebar-pretitle{padding:0.4em 0.4em 0;line-height:1.2em}.mw-parser-output .sidebar-title,.mw-parser-output .sidebar-title-with-pretitle{padding:0.2em 0.8em;font-size:145%;line-height:1.2em}.mw-parser-output .sidebar-title-with-pretitle{padding:0.1em 0.4em}.mw-parser-output .sidebar-image{padding:0.2em 0.4em 0.4em}.mw-parser-output .sidebar-heading{padding:0.1em 0.4em}.mw-parser-output .sidebar-content{padding:0 0.5em 0.4em}.mw-parser-output .sidebar-content-with-subgroup{padding:0.1em 0.4em 0.2em}.mw-parser-output .sidebar-above,.mw-parser-output .sidebar-below{padding:0.3em 0.8em;font-weight:bold}.mw-parser-output .sidebar-collapse .sidebar-above,.mw-parser-output .sidebar-collapse .sidebar-below{border-top:1px solid #aaa;border-bottom:1px solid #aaa}.mw-parser-output .sidebar-navbar{text-align:right;font-size:115%;padding:0 0.4em 0.4em}.mw-parser-output .sidebar-list-title{padding:0 0.4em;text-align:left;font-weight:bold;line-height:1.6em;font-size:105%}.mw-parser-output .sidebar-list-title-c{padding:0 0.4em;text-align:center;margin:0 3.3em}@media(max-width:640px){body.mediawiki .mw-parser-output .sidebar{width:100%!important;clear:both;float:none!important;margin-left:0!important;margin-right:0!important}}body.skin--responsive .mw-parser-output .sidebar a>img{max-width:none!important}@media screen{html.skin-theme-clientpref-night .mw-parser-output .sidebar:not(.notheme) .sidebar-list-title,html.skin-theme-clientpref-night .mw-parser-output .sidebar:not(.notheme) .sidebar-title-with-pretitle{background:transparent!important}html.skin-theme-clientpref-night .mw-parser-output .sidebar:not(.notheme) .sidebar-title-with-pretitle a{color:var(--color-progressive)!important}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .sidebar:not(.notheme) .sidebar-list-title,html.skin-theme-clientpref-os .mw-parser-output .sidebar:not(.notheme) .sidebar-title-with-pretitle{background:transparent!important}html.skin-theme-clientpref-os .mw-parser-output .sidebar:not(.notheme) .sidebar-title-with-pretitle a{color:var(--color-progressive)!important}}@media print{body.ns-0 .mw-parser-output .sidebar{display:none!important}}

/* end https://en.wikipedia.org/ */

</style><table class="sidebar nomobile nowraplinks hlist"><tbody><tr><td class="sidebar-pretitle" style="background:#b6e3c9;;padding-top:0.4em;">Part of a series on</td></tr><tr><th class="sidebar-title-with-pretitle" style="background:#b6e3c9;;padding-top:0;"><a href="Medical_ethics" title="Medical ethics">Medical ethics</a></th></tr><tr><th class="sidebar-heading" style="background:#b6e3c9;;border-top:1px #b6e3c9 solid;">

Values</th></tr><tr><td class="sidebar-content">

<ul><li><a href="Primum_non_nocere" title="Primum non nocere">Primum non nocere</a></li>

<li><a href="Informed_consent" title="Informed consent">Informed consent</a></li>

<li><a href="Beneficence_(ethics)" title="Beneficence (ethics)">Beneficence</a></li>

<li><a href="Confidentiality" title="Confidentiality">Confidentiality</a></li>

<li><a href="Autonomy" title="Autonomy">Autonomy</a></li></ul></td>

</tr><tr><th class="sidebar-heading" style="background:#b6e3c9;;border-top:1px #b6e3c9 solid;">

Conflicts</th></tr><tr><td class="sidebar-content">

<ul><li><a href="Capacity_(law)" title="Capacity (law)">Capacity</a></li>

<li><a href="Conflict_of_interest_in_the_healthcare_industry" title="Conflict of interest in the healthcare industry">Conflict of interest</a>

<ul><li><a href="Separation_of_prescribing_and_dispensing" title="Separation of prescribing and dispensing">Separation of prescribing and dispensing</a></li>

<li><a href="Health_care_rationing" title="Health care rationing">Health care rationing</a></li></ul></li>

<li><a href="Involuntary_treatment" title="Involuntary treatment">Involuntary treatment</a></li>

<li><a href="Duty_to_protect" title="Duty to protect">Duty to protect</a></li>

<li><a href="List_of_medical_ethics_cases" title="List of medical ethics cases">Cases</a></li></ul></td>

</tr><tr><th class="sidebar-heading" style="background:#b6e3c9;;border-top:1px #b6e3c9 solid;">

Frameworks</th></tr><tr><td class="sidebar-content">

<ul><li><a href="Advance_healthcare_directive" title="Advance healthcare directive">Advance healthcare directive</a></li>

</ul></td>

</tr><tr><th class="sidebar-heading" style="background:#b6e3c9;;border-top:1px #b6e3c9 solid;">

Related Concepts</th></tr><tr><td class="sidebar-content">

<ul><li><a href="Medical_profession" class="mw-redirect" title="Medical profession">Medical profession</a></li>

<li><a href="Medical_law" title="Medical law">Medical law</a></li>

<li><a href="Bioethics" title="Bioethics">Bioethics</a></li></ul></td>

</tr><tr><th class="sidebar-heading" style="background:#b6e3c9;;border-top:1px #b6e3c9 solid;">

Critiques</th></tr><tr><td class="sidebar-content">

<ul><li><a href="Medical_sociology" title="Medical sociology">Medical sociology</a></li></ul></td>

</tr><tr><td class="sidebar-navbar"><style data-mw-deduplicate="TemplateStyles:r1239400231">

/* start https://en.wikipedia.org/ */

.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}

/* end https://en.wikipedia.org/ */

</style></td></tr></tbody></table>

A surrogate decision maker, also known as a <a href="Health_care_proxy" class="mw-redirect" title="Health care proxy">health care proxy</a> or as agents, is an <a href="Advocacy" title="Advocacy">advocate</a> for incompetent <a href="Patient" title="Patient">patients</a>. If a patient is unable to make decisions for themselves about personal care, a surrogate agent must make decisions for them. If there is a durable <a href="Power_of_attorney" title="Power of attorney">power of attorney</a> for health care, the agent appointed by that document is authorized to make health care decisions within the scope of authority granted by the document. If people have court-appointed guardians with authority to make health care decisions, the guardian is the authorized surrogate.<a href="#cite_note-Sabatino-1">[1]</a>

<div class="mw-heading mw-heading2"><h2 id="Background">Background</h2></div>

At the 1991 Annual Meeting of the <a href="American_Medical_Association" title="American Medical Association">American Medical Association</a>, the AMA adopted the report of the Council on Ethical and Judicial Affairs known as, "Decisions to Forgo Life-Sustaining Treatment for Incompetent Patients." The recommendations of the report were the basis for amendments to Opinion 2.20 known as, "Withholding or Withdrawing Life-Sustaining Medical Treatment." The report itself provides guidelines for <a href="Physician" title="Physician">physicians</a> who may have to identify a surrogate decision maker, assist a surrogate (<a href="Agent_(law)" class="mw-redirect" title="Agent (law)">proxy</a>) in making decisions for <a href="Competence_(law)" title="Competence (law)">incompetent</a> patients, and resolve conflicts that may arise between decision makers, or between the decision maker's choice and medically appropriate options. Since the first incorporation of these guidelines to the AMA Code of Medical Ethics, the council has deferred to Opinion 2.20 to address <a href="Inquiries" class="mw-redirect" title="Inquiries">inquiries</a> involving surrogate decision making, even though the guidelines presented in this Opinion refer only to decisions made near the end of life.

With continued discussion concerning health care preferences for all patients, including those who are incompetent, greater options have been made available to secure health care directives. The involvement of third parties in a patient's <a href="Health" title="Health">health</a> becomes more likely in decisions that may occur in instances other than the end of life.

In addition, the council recognizes that there is a spectrum of decision-making capacity ranging from <a href="Maturity_(psychological)" title="Maturity (psychological)">immaturity</a>, to <a href="Mental_illness" class="mw-redirect" title="Mental illness">mental illness</a>, to serious <a href="Brain_damage" class="mw-redirect" title="Brain damage">brain damage</a>, and that health care decisions often must be made for individuals with diminished decisional faculties over extended periods of time. The council offers the following report to expand on its previous guidelines and to identify features related to a meaningful and effective <a href="Physician" title="Physician">physician</a>-proxy relationship.

The report begins by defining a number of terms related to health care directives before presenting theoretical frameworks used in making decisions for incompetent patients. It then provides a protocol for identifying a surrogate decision maker as well as guidance for physicians who may run into conflict either assisting the surrogate in coming to a decision or with the decision itself. Finally, the report offers guidelines for nurturing an effective <a href="Physician" title="Physician">physician</a>-proxy relationship.<a href="#cite_note-Sabatino-1">[1]</a>

A study was conducted aiming to describe physicians' experiences with surrogate communication and decision making for hospitalized adults. It was concluded that physician-surrogate decision making may be enhanced if patients discuss their preferences in advance and if physician contact with surrogate decision makers is facilitated.<a href="#cite_note-torke-2">[2]</a> A further study by the same group of researchers was conducted exploring the degree to which physicians report reliance on patient preferences when making medical decisions for hospitalized patients lacking decisional capacity. Although a majority of physicians identified patient preferences as the most important general ethical guideline for surrogate decision-making, they relied on a variety of factors when making treatment decisions for a patient lacking decisional capacity.<a href="#cite_note-torke2-3">[3]</a>

<div class="mw-heading mw-heading2"><h2 id="Designating_a_surrogate_decision_maker">Designating a surrogate decision maker</h2></div>

The Patient Self-Determination Act guarantees a patient's right to formally designate a surrogate to make treatment decisions for the patient if the patient becomes unable to make their own decisions. A surrogate decision-maker, or durable power of attorney for health care (DPA/HC), must be documented. A common form that is valid in 40 states is <a href="Five_Wishes" title="Five Wishes">Five Wishes</a>.<a href="#cite_note-4">[4]</a><a href="#cite_note-5">[5]</a>

When filing an <a href="Advance_directive" class="mw-redirect" title="Advance directive">advance directive</a>, an alternate health care agent should be identified. The surrogate decision maker must be a trusted individual that is able to make crucial decisions on behalf of the advance directive client. The advance directive should also indicate specific instructions for when a patient is incapacitated. Treatment options should be examined and discussed with a physician, <a href="Lawyer" title="Lawyer">attorney</a>, and family members. Common instructions might include instruction surrounding the use of a <a href="Feeding_tube" title="Feeding tube">feeding tube</a>. The client's inclinations must be clearly written, and the health care agent should fully understand the instructions given as well as how to execute them.<a href="#cite_note-6">[6]</a>

When drafting a <a href="Health_care_proxy" class="mw-redirect" title="Health care proxy">health care proxy</a>, it is best to consult a <a href="Physician" title="Physician">physician</a> and attorney. The forms are available through <a href="Lawyers" class="mw-redirect" title="Lawyers">lawyers</a>, <a href="Hospitals" class="mw-redirect" title="Hospitals">hospitals</a>, and websites dedicated to health care ethics. The proxy must identify the client and the client's agent, also including all contact information. The advance directive must state that the designated agent has authority to make health care decisions on the patient's behalf and what limitations, if any, are imposed on the agent's authority. The document should clearly state that the agent's <a href="Authority" title="Authority">authority</a> begins only when the patent is unable to make health care decisions. When the document is finished, it must be signed and have been witnessed by two individuals who are not the agents, <a href="Caregivers" class="mw-redirect" title="Caregivers">caregivers</a>, or relatives to the patient. The completed document should be signed by the witnesses and the client of the advance directive. The document should be given to the patent's physician, <a href="Lawyer" title="Lawyer">lawyer</a>, spouse/partner, and family. The advance directive should be reviewed regularly and reflect changes in the client's current marital situation (e.g. <a href="Marriage" title="Marriage">marriage</a> or <a href="Divorce" title="Divorce">divorce</a>). For the agent to view the medical records of the client, the client should sign a <a href="HIPAA" class="mw-redirect" title="HIPAA">HIPAA</a> (Health Insurance Portability and Accountability Act) release form.<a href="#cite_note-7">[7]</a><a href="#cite_note-8">[8]</a>

<div class="mw-heading mw-heading2"><h2 id="Criteria_for_being_a_surrogate_agent">Criteria for being a surrogate agent</h2></div>

In the event that a surrogate decision maker has not been identified through either a medical power of attorney or a court-appointed legal guardian, such an agent is selected by <a href="Medical_personnel" class="mw-redirect" title="Medical personnel">medical personnel</a>. A <a href="Patient" title="Patient">patient</a> must meet a certain set of criteria prior to the legal selection of a health care surrogate agent. The patient must have a disabling condition such as a mental illness or infirmity, an impairment in the ability to complete activities of <a href="Daily_living_skills" class="mw-redirect" title="Daily living skills">daily living</a>, <a href="Cognitive_impairment" title="Cognitive impairment">cognitive impairment</a>, and a lack of any previously indicated alternative to <a href="Guardianship" class="mw-redirect" title="Guardianship">guardianship</a>. This person is chosen by either the <a href="Attending_physician" title="Attending physician">attending physician</a> or their advance practice <a href="Nurse" class="mw-redirect" title="Nurse">nurse</a>.<a href="#cite_note-9">[9]</a>

In the US, hierarchy of health care surrogates may vary according to the law of the specific state, but an example order of priority is listed here:

<ol><li>The client's guardian</li>

<li>The client's spouse</li>

<li>Any adult son or daughter of the client</li>

<li>Either parent of the client</li>

<li>Any adult <a href="Sibling" title="Sibling">brother or sister</a> of the client</li>

<li>Any adult grandchild of the client, or an adult relative who has exhibited special care and concern, who has maintained close contact, and who is familiar with the patient's activities, health, and religious or moral beliefs</li>

<li>A close friend of the client</li>

<li>The client's guardian of the estate<a href="#cite_note-10">[10]</a><a href="#cite_note-11">[11]</a></li></ol>

When there are multiple candidates at the same level of priority in the hierarchal structure, it becomes their duty to reach an agreement in regard to decisions and care of the patient. If such surrogate agents are unable to develop a consensus, the physician looks to the majority of agents in that category.<a href="#cite_note-Illinois_General_Assembly-12">[12]</a>

If an agent of greater <a href="Hierarchy" title="Hierarchy">hierarchy</a> becomes available than the current identified agent, the person of higher precedence has priority. If any agent becomes unavailable, the <a href="Physician" title="Physician">physician</a> returns to the hierarchal structure to indicate the next candidate.<a href="#cite_note-Illinois_General_Assembly-12">[12]</a>

A prime example of this would be <a href="Nancy_Cruzan" class="mw-redirect" title="Nancy Cruzan">Nancy Cruzan</a>. This case has helped to establish some principles of surrogacy, such as using the person who best knows the patient rather than just the <a href="Next_of_kin" title="Next of kin">next of kin</a>.

<div class="mw-heading mw-heading3"><h3 id="Controversial_agents">Controversial agents</h3></div>

Any health care surrogate agent is granted the same rights in regard to access of medical information and decision-making as would the alert and competent patient. These rights remain until such time as the client regains <a href="Decisional_capacity" class="mw-redirect" title="Decisional capacity">decisional capacity</a>, a guardian is appointed, or the patient's death occurs. All health care surrogates are expected to follow the same set of standards: patient's known wishes, substituted judgments, and patient's best interests.<a href="#cite_note-Illinois_General_Assembly-12">[12]</a><a href="#cite_note-13">[13]</a>

The following people are denied the ability to act as a health care surrogate:

<ol><li>The client's treating health care provider</li>

<li>An employee of the treating health care provider, unless that employee is a relation of the patient</li>

<li>Owner, <a href="Management" title="Management">operator</a>, or administrator of the patient's current health care facility</li>

<li>An employee of an owner, operator, or administrator of the patient's current health care facility, unless that employee is a relation of the patient <a href="#cite_note-14">[14]</a></li></ol>

<div class="mw-heading mw-heading2"><h2 id="Powers_and_limitations_of_a_surrogate">Powers and limitations of a surrogate</h2></div>

A surrogate decision-maker must use the <a href="Doctrine" title="Doctrine">doctrine</a> of substituted judgment in consenting to or refusing health care on behalf of an incompetent individual. All surrogates, whether appointed by the person, by default, or by the court, have an <a href="Obligation" title="Obligation">obligation</a> to follow the expressed wishes of the adult person and to act in the person's best interests, taking into account the person's values if known. If no advance directives are available, the proxy should use the principle of substituted judgment by considering what the patient would want in the given situation. This may require further discussion with others who knew the patient prior to the current period of incapacity.<a href="#cite_note-Sabatino-1">[1]</a><a href="#cite_note-15">[15]</a>

Occasionally, there is simply no information available about this patient's wishes and a "reasonable person" or <a href="Best_interest" class="mw-redirect" title="Best interest">best interest</a> standard is applied by the hospital care team. This standard is used when the patient's values are unknown. The best interest's standard is the least preferred standard because surrogates use their own values to decide what is in the patient's best interests—which places a heavy burden on the surrogate. The agent should not be given the power to make decisions against the patient's will, and does not take away the right to make decisions from the patient. This is no longer effective when the agent knows that the patient has died.<a href="#cite_note-16">[16]</a><a href="#cite_note-17">[17]</a><a href="#cite_note-18">[18]</a>

<div class="mw-heading mw-heading2"><h2 id="Conflicts_of_interest">Conflicts of interest</h2></div>

A <a href="Conflict_of_interest" title="Conflict of interest">conflict of interest</a> occurs when an individual or organization is involved in multiple interests, one of which could possibly corrupt the motivation for an act in the other. For example, a woman marries a wealthy man. In his final will, the man wants to leave his multi-million dollar estate to his wife. Soon after this occurs, the man becomes ill and falls into an unconscious <a href="Persistent_vegetative_state" class="mw-redirect" title="Persistent vegetative state">persistent vegetative state</a>. The wife believes that the care team should take her husband off <a href="Life_support" title="Life support">life support</a> and allow him to die. In this situation, the care team would have to take into account that a <a href="Conflict_of_interest" title="Conflict of interest">conflict of interest</a> could be present. There are other examples of cases following the links listed below.<a href="#cite_note-19">[19]</a>

<div class="mw-heading mw-heading3"><h3 id="Best_interests_standard">Best interests standard</h3></div>

The <a href="Best_interest" class="mw-redirect" title="Best interest">best interest</a> standard is defined as the best possible outcome for patient in a given situation, the outcome that provides the most benefit to the patient. The values of the client must be taken into account. Religion, any beliefs related to life and death. What are the patient's best interests? Some best interests in order of their standards include life at any cost, freedom from pain, <a href="Rationality" title="Rationality">rationality</a>, and <a href="Dignity" title="Dignity">dignity</a>. It is all in what the patient chooses to be of utmost importance to them.<a href="#cite_note-20">[20]</a>

<div class="mw-heading mw-heading2"><h2 id="Laws_related_to_surrogacy_in_the_US">Laws related to surrogacy in the US</h2></div>

To decide for themselves, the patient must be competent to decide. This means that the patient must be <a href="Conscious" class="mw-redirect" title="Conscious">conscious</a> and able to choose the option they feel is best for their <a href="Health" title="Health">health</a> and well-being. This must be fulfilled first under any circumstance. However, there are some exceptions. Some states have passed laws allowing incompetent patients with certified <a href="Mental_illness" class="mw-redirect" title="Mental illness">mental illness</a> to speak for themselves regarding decision-making. <a rel="nofollow" class="external autonumber" href="http://www.leg.state.vt.us/statutes/sections.cfm?Title=18&Chapter=231">[1]</a>

<div class="mw-heading mw-heading3"><h3 id="Current_status_of_the_law">Current status of the law</h3></div>

Adults that are considered <a href="Competence_(law)" title="Competence (law)">competent</a> have the right to refuse treatment. As stated above, some states allow incompetent adults to refuse treatment. There can also be recommended termination of medical treatment for incompetent adults by a physician. Two tests for competency are the substituted judgment test and the best interests test.

Current statutory solutions include living wills or <a href="Advance_directives" class="mw-redirect" title="Advance directives">advance directives</a> that explain the patient's wishes in certain medical situations. A durable <a href="Power_of_attorney" title="Power of attorney">power of attorney</a> for health care (DPA/HC) and is another way of identifying a patient's final wishes through an attorney. The patient <a href="Self-determination" title="Self-determination">self-determination</a> act states that hospitals and health care facilities must provide information about <a href="Advance_directives" class="mw-redirect" title="Advance directives">advance directives</a> and DPA/HC. Also, a <a href="Agent_(law)" class="mw-redirect" title="Agent (law)">proxy</a> or surrogate decision-maker can provide these final wishes to the doctor or care team if a DPA/HC or AD is not present.

Some <a href="Fictional" class="mw-redirect" title="Fictional">fictional</a> assumptions underlying judicial decisions include the following misconceptions:

1. It is better to make a mistake in favor of preserving the patient's <a href="Life" title="Life">life</a>. This is an all too common misconception about surrogate decision-making, and another reason why it is so important to have a DPA/HC or AD. In most cases, patients wish to have a death free from pain, and wish to be only provided with comfort care during the remaining hours of their <a href="Life" title="Life">life</a>.

2. The state has an interest in preserving <a href="Life" title="Life">life</a>. Although <a href="Euthanasia" title="Euthanasia">euthanasia</a> is illegal in the US, Physician <a href="Assisted_suicide" title="Assisted suicide">assisted suicide</a> has been passed in some states.

3. Most people want to be kept "alive" by <a href="Machines" class="mw-redirect" title="Machines">machines</a>. Most people don't want to drain their family's funds to keep them alive especially when they are in a <a href="Persistent_vegetative_state" class="mw-redirect" title="Persistent vegetative state">persistent vegetative state</a> with no possible chance for <a href="Healing" title="Healing">recovery</a>. In these cases, it is often weighing the risks and benefits of keeping the patient breathing, when they are clearly not living their life to its full potential.

4. There is no harm in postponing the decision. Often postponing the decision to keep a person on <a href="Life_support" title="Life support">life support</a> drains <a href="Resources" class="mw-redirect" title="Resources">resources</a> and funds.

5. <a href="Youth" title="Youth">Youth</a> withdraw medical treatment from the elderly. Usually the next of <a href="Kinship" title="Kinship">kin</a> to the elderly are younger, and know what the best interests of the elderly are and have discussed. Although at times it is difficult to explain the wishes of the patient to the <a href="Physician" title="Physician">physician</a> or care team when the <a href="Agent_(law)" class="mw-redirect" title="Agent (law)">proxy</a> disagrees with the patient they are representing.

6. The <a href="Family" title="Family">family</a> may terminate medical treatment for financial reasons. It is difficult for a family member to see another family member suffer from illness or in pain, which is often why family members refrain from life support or a <a href="Feeding_tube" title="Feeding tube">feeding tube</a>.

7. Removal of life-sustaining treatment is a step toward <a href="Euthanasia" title="Euthanasia">euthanasia</a>. <a href="Euthanasia" title="Euthanasia">Euthanasia</a> and sustaining from treatment are completely different aspects of death. <a href="Euthanasia" title="Euthanasia">Euthanasia</a> is usually taking an active approach to the death of a patient while removing treatment simply allows the patient to die from their illness while providing them comfort care.

8. The religious oppose termination of life-sustaining treatment. Freedom from pain and comfort care is most often the humane way and accepted by most all religions.<a href="#cite_note-21">[21]</a>

<div class="mw-heading mw-heading2"><h2 id="References">References</h2></div>

/* start https://en.wikipedia.org/ */

.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}

/* end https://en.wikipedia.org/ */

</style><div class="reflist">

/* start https://en.wikipedia.org/ */

.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("./mw/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("./mw/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("./mw/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("./mw/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}

/* end https://en.wikipedia.org/ */

</style><cite id="CITEREFSabatino2007" class="citation web cs1">Sabatino, Charles (2007). <a rel="nofollow" class="external text" href="http://www.merck.com/mmhe/sec01/ch009/ch009f.html">"Surrogate Decision Making"</a>.</cite>

</li>

<li id="cite_note-torke-2"><a href="#cite_ref-torke_2-0">^</a> <cite id="CITEREFTorkeSiegler_MAbalos_AMoloney_RM2009" class="citation journal cs1">Torke, AM; Siegler M; Abalos A; Moloney RM; Alexander GC (September 2009). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726893">"Physicians' Experience with Surrogate Decision Making for Hospitalized Adults"</a>. Journal of General Internal Medicine. 24 (9): 1023–1028. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs11606-009-1065-y">10.1007/s11606-009-1065-y</a>. <a href="PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726893">2726893</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/19633896">19633896</a>.</cite>

</li>

<li id="cite_note-torke2-3"><a href="#cite_ref-torke2_3-0">^</a> <cite id="CITEREFTorkeMoloney_RSiegley_MAbalos_A2010" class="citation journal cs1">Torke, AM; Moloney R; Siegley M; Abalos A; Alexander GC (March 2010). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3513265">"Physicians' views on the importance of patient preferences in surrogate decision-making"</a>. Journal of the American Geriatrics Society. 58 (3): 533–538. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1532-5415.2010.02720.x">10.1111/j.1532-5415.2010.02720.x</a>. <a href="PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3513265">3513265</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/20158556">20158556</a>.</cite>

</li>

<li id="cite_note-4"><a href="#cite_ref-4">^</a> <cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20221006162952/https://www.abanet.org/publiced/practical/patient_self_determination_act.html">"American Bar Association"</a>. Archived from <a rel="nofollow" class="external text" href="http://www.abanet.org/publiced/practical/patient_self_determination_act.html">the original</a> on 2022-10-06. Retrieved 2010-04-22.</cite>

</li>

<li id="cite_note-5"><a href="#cite_ref-5">^</a> <cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20090514000437/http://www.agingwithdignity.org/five-wishes.php">"Aging with Dignity"</a>. 2009. Archived from <a rel="nofollow" class="external text" href="http://www.agingwithdignity.org/five-wishes.php">the original</a> on 2009-05-14.</cite>

</li>

<li id="cite_note-6"><a href="#cite_ref-6">^</a> <cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.ascensionhealth.org/index.php?option=com_content&view=article&id=48&Itemid=172">"Issues and Concepts"</a>. Ascension Health. 2009.</cite>

</li>

<li id="cite_note-7"><a href="#cite_ref-7">^</a> <cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.massmed.org/AM/Template.cfm?Section=Home6&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=2570">"Massachusetts Medical Society"</a>. 2010.</cite>

</li>

<li id="cite_note-8"><a href="#cite_ref-8">^</a> <cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20151206135630/http://www.hhs.gov/ocr/privacy">"Health Information Privacy"</a>. HHS. 2015-08-26. Archived from <a rel="nofollow" class="external text" href="https://www.hhs.gov/ocr/privacy/">the original</a> on 2015-12-06. Retrieved 2017-09-15.</cite>

</li>

<li id="cite_note-9"><a href="#cite_ref-9">^</a> <cite id="CITEREFGavisk_&_GreeneGreene2007" class="citation journal cs1">Gavisk & Greene; Greene, Edith (2007). "Guardianship Determinations by Judges, Attorneys, and Guardians". Behavioral Sciences & the Law. 25 (3): 339–353. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1002%2Fbsl.772">10.1002/bsl.772</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/17559155">17559155</a>. <a href="S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:15994936">15994936</a>.</cite>

</li>

<li id="cite_note-10"><a href="#cite_ref-10">^</a> <cite id="CITEREFIllinois_General_Assembly" class="citation web cs1">Illinois General Assembly. <a rel="nofollow" class="external text" href="http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2111&ChapAct=755%26nbsp%3BILCS%26nbsp%3B40%2F&ChapterID=60&ChapterName=ESTATES&ActName=Health+Care+Surroga">"Health Care Surrogate Act"</a>.</cite>

</li>

<li id="cite_note-11"><a href="#cite_ref-11">^</a> <cite id="CITEREFThe_Florida_Senate" class="citation web cs1">The Florida Senate. <a rel="nofollow" class="external text" href="http://www.flsenate.gov/Statutes/index.cfm?App_mode=Display_Statute&URL=Ch0765/ch0765.htm">"The 2009 Florida Statutes: Health Care Advance Directives"</a>.</cite>

</li>

<li id="cite_note-Illinois_General_Assembly-12">^ <a href="#cite_ref-Illinois_General_Assembly_12-0">a</a> <a href="#cite_ref-Illinois_General_Assembly_12-1">b</a> <a href="#cite_ref-Illinois_General_Assembly_12-2">c</a> Illinois General Assembly

</li>

<li id="cite_note-13"><a href="#cite_ref-13">^</a> <cite id="CITEREFBergerDeRenzoSchwartz2008" class="citation journal cs1">Berger; DeRenzo; Schwartz (2008). "Surrogate Decision Making: Reconciling Ethical Theory and Clinical Practice". Annals of Internal Medicine. 149 (1): 48–53. <a href="CiteSeerX_(identifier)" class="mw-redirect" title="CiteSeerX (identifier)">CiteSeerX</a> <a rel="nofollow" class="external text" href="https://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.691.1213">10.1.1.691.1213</a>. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.7326%2F0003-4819-149-1-200807010-00010">10.7326/0003-4819-149-1-200807010-00010</a>. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/18591637">18591637</a>. <a href="S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:24744848">24744848</a>.</cite>

</li>

<li id="cite_note-14"><a href="#cite_ref-14">^</a> <cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.wvlegalservices.org">"Health Care Surrogates: What do I need to know?"</a>. Appalachian Legal Services.</cite>

</li>

<li id="cite_note-15"><a href="#cite_ref-15">^</a> <cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.wsha.org/page.cfm?ID=EOL-SurrogateDecisions">"End of Life Care Manual"</a>. Washington State Hospital Association. 2005.</cite>

</li>

<li id="cite_note-16"><a href="#cite_ref-16">^</a> <cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.brown.edu/Departments/Center_for_Biomedical_Ethics/AD.html">"Advance Directives Module for Internal Medicine Clerkship"</a>. University of Toronto.</cite>

</li>

<li id="cite_note-17"><a href="#cite_ref-17">^</a> <cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.pages.drexel.edu/~cp28/surdec.htm">"Surrogate Decision Making"</a>. Drexel University. 2006.</cite>

</li>

<li id="cite_note-18"><a href="#cite_ref-18">^</a> <cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.hhs.state.ne.us/ags/docs/miltc.pdf">"Surrogate Decision Making in Nebraska"</a> (PDF). Nebraska Department of Health and Human Services. 2007.</cite>

</li>

<li id="cite_note-19"><a href="#cite_ref-19">^</a> <cite id="CITEREFFiore2010" class="citation web cs1">Fiore, Kristina (2010). <a rel="nofollow" class="external text" href="http://www.medpagetoday.com/PublicHealthPolicy/Ethics/18991">"Conflicts of Interests Policies: A Detailed Look"</a>.</cite>

</li>

<li id="cite_note-20"><a href="#cite_ref-20">^</a> <cite id="CITEREFPierce,_J.Randels,_G.2009" class="citation book cs1">Pierce, J.; Randels, G. (2009). Contemporary Bioethics: A Reader with Cases. USA: Oxford University Press. <a href="ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <bdi>978-0-19-531382-6</bdi>.</cite>

</li>

<li id="cite_note-21"><a href="#cite_ref-21">^</a> <cite id="CITEREFHamman1993" class="citation journal cs1">Hamman, Ardath (1993). <a rel="nofollow" class="external text" href="http://heinonline.org/HOL/LandingPage?collection=journals&handle=hein.journals/vllalr38&div=10&id=&page=">"Family Surrogate Laws: A Necessary Supplement to Living Wills and Durable Powers of Attorney"</a>. Villanova Law Review. 38 (1): 103–77. <a href="PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11654083">11654083</a>.</cite>

</li>

</ol></div></div>

<div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2></div>

<ul><li><a rel="nofollow" class="external text" href="http://journals.lww.com/ccmjournal/Abstract/2003/05001/Moral_justifications_for_surogate_decision_making.3.aspx">Moral Justifications for Surrogate Decision-Making</a></li>

<li><a rel="nofollow" class="external text" href="http://journals.lww.com/alzheimerjournal/Abstract/2003/04001/Surrogate_Decision_king_and_Related_Issues.3.aspx">Proxy Consent and Surrogate Decision-Making</a></li>

<li><a rel="nofollow" class="external text" href="http://www.lawdepot.com/contracts/healthdir/?a=t&pid=google-health_usproxy_a1&s_kwcid=healthcare%20proxy%7C485090949&gclid=CLiRpJHYu6ACFSJ25Qo5QLtTw">Health Care Directive Form</a></li>

<li><a rel="nofollow" class="external text" href="http://www.scu.edu/ethics/publications/iie/v11n1/custody.html">The Best Interest of the Child</a></li>

This article is issued from <a class="external text" title="Last edited on 2025-07-27" href="https://en.wikipedia.org/wiki/?title=Surrogate_decision-maker&oldid=1302827262">Wikipedia</a>. The text is available under <a class="external text" href="https://creativecommons.org/licenses/by-sa/4.0/deed.en">Creative Commons Attribution-Share Alike 4.0</a> unless otherwise noted. Additional terms may apply for the media files.

</div>

</div></div>

</div>

</main>

</div>

</body></html>