It’s Not How Surrogates “Decide” that Matters: Appreciating the Role Surrogates Play

Excerpt

On what basis should a surrogate contribute to decision-making regarding a patient’s treatment? As Devnani et al. imply in the current issue of JGIM by referencing the work of the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research from 1983, this question seems to have been settled for over 30 years: surrogates should rely on patients’ preferences.1 Only when such preference are unknown, Devnani and colleagues continue, should surrogates “act upon the ethical principle of beneficence by making decisions in order to maximize patient well-being.”1 It is against this background that the authors set out to explore whether, in fact, surrogates actually follow this theoretically oriented set of rules. Given the preponderance of ethical discussion within both the medical and bioethics literature that relies on the seemingly a priori acceptance of this theoretical frame, turning attention to how real people in actual medical circumstances participate in decision-making for a loved one is of major importance, and for that reason alone, Devnani et al.’s contribution is worthwhile. …